Primary care spirometry is a uniquely valuable tool in the evaluation of patients with respiratory symptoms, allowing the general practitioner to diagnose or exclude chronic obstructive pulmonary disease (COPD), sometimes to confirm asthma, to determine the efficacy of asthma treatment and to correctly stage patients with COPD. The use of spirometry for case finding in asymptomatic COPD patients might become an option, once early intervention studies have shown it to be beneficial in these patients. The diagnosis of airway obstruction requires accurate and reproducible spirometric measurements, which should comply with the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. Low acceptability of spirometric manoeuvres has been reported in primary care practices. This may hamper the validity of the results and affect clinical decision making. Training and refresher courses may produce and maintain good-quality testing, promote the use of spirometric results in clinical practice and enhance the quality of interpretation. Softening the stringent ATS/ERS criteria could enhance the acceptability rates of spirometry when used in a general practice. However, the implications of potential simplifications on the quality of the data and clinical decision making remain to be investigated. Hand-held office spirometers have been developed in recent years, with a global quality and user-friendliness that makes them acceptable for use in general practices. The precision of the forced vital capacity measurements could be improved in some of the available models.

BackgroundOur objective was to develop a tool to identify patients with COPD for proactive palliative care. Since palliative care needs increase during the disease course of COPD, the prediction of mortality within 1 year, measured during hospitalizations for acute exacerbation COPD (AECOPD), was used as a proxy for the need of proactive palliative care.Patients and methodsPatients were recruited from three general hospitals in the Netherlands in 2014. Data of 11 potential predictors, a priori selected based on literature, were collected during hospitalization for AECOPD. After 1 year, the medical files were explored for the date of death. An optimal prediction model was assessed by Lasso logistic regression, with 20-fold cross-validation for optimal shrinkage. Missing data were handled using complete case analysis.ResultsOf 174 patients, 155 patients were included; of those 30 (19.4%) died within 1 year. The optimal prediction model was internally validated and had good discriminating power (AUC =0.82, 95% CI 0.81–0.82). This model relied on the following seven predictors: the surprise question, Medical Research Council dyspnea questionnaire (MRC dyspnea), Clinical COPD Questionnaire (CCQ), FEV1% of predicted value, body mass index, previous hospitalizations for AECOPD and specific comorbidities. To ensure minimal miss out of patients in need of proactive palliative care, we proposed a cutoff in the model that prioritized sensitivity over specificity (0.90 over 0.73, respectively). Our model (ProPal-COPD tool) was a stronger predictor of mortality within 1 year than the CODEX (comorbidity, age, obstruction, dyspnea, and previous severe exacerbations) index.ConclusionThe ProPal-COPD tool is a promising multivariable prediction tool to identify patients with COPD for proactive palliative care.

BackgroundSince its launch in 2003, the Dutch Lung Cancer Information Center’s (DLIC) website has become increasingly popular. The most popular page of the website is the section “Ask the Physician”, where visitors can ask an online lung specialist questions anonymously and receive an answer quickly. Most questions were not only asked by lung cancer patients but also by their informal caregivers. Most questions concerned specific information about lung cancer.ObjectiveOur goal was to explore the reasons why lung cancer patients and caregivers search the Internet for information and ask online lung specialists questions on the DLIC’s interactive page, “Ask the Physician”, rather than consulting with their own specialist.MethodsThis research consisted of a qualitative study with semistructured telephone interviews about medical information-seeking behavior (eg, information needs, reasons for querying online specialists). The sample comprised 5 lung cancer patients and 20 caregivers who posed a question on the interactive page of the DLIC website.ResultsRespondents used the Internet and the DLIC website to look for lung cancer–related information (general/specific to their personal situation) and to cope with cancer. They tried to achieve a better understanding of the information given by their own specialist and wanted to be prepared for the treatment trajectory and disease course. This mode of information supply helped them cope and gave them emotional support. The interactive webpage was also used as a second opinion. The absence of face-to-face contact made respondents feel freer to ask for any kind of information. By being able to pose a question instantly and receiving a relatively quick reply from the online specialist to urgent questions, respondents felt an easing of their anxiety as they did not have to wait until the next consultation with their own specialist.ConclusionsThe DLIC website with its interactive page is a valuable complementary mode of information supply and supportive care for lung cancer patients and caregivers.

Given the number of visitors to the lung cancer Web site, it can be concluded that there is a great need for additional information among patients and caregivers. The launched Web site www.longkanker.info has reached its goal of providing a dependable source of information about lung cancer and satisfying its visitors.

BackgroundChronic obstructive pulmonary disease (COPD) and asthma are underdiagnosed in primary care. AimTo determine how often COPD or asthma are present in middle-aged and older patients who consult their GP for persistent cough. Design of studyA cross-sectional study in 353 patients older than 50 years, visiting their GP for persistent cough and not known to have COPD or asthma. SettingGeneral practice in the Netherlands. MethodAll participants underwent extensive diagnostic workup, including symptoms, signs, spirometry, and body plethysmography. All results were studied by an expert panel to diagnose or exclude COPD and/or asthma. The reproducibility of the panel diagnosis was assessed by calculation of Cohen's κ statistic in a sample of 41 participants. ResultsOf the 353 participants, 102 (29%, 95% confidence interval [CI] = 24 to 34%) were diagnosed with COPD. In 14 of these 102 participants, both COPD and asthma were diagnosed (4%, 95% CI = 2 to 7%). Asthma (without COPD) was diagnosed in 23 (7%, 95% CI = 4 to 10%) participants. Mean duration of cough was 93 days (median 40 days). The reproducibility of the expert panel was good (Cohen's κ = 0.90). ConclusionIn patients aged over 50 years who consult their GP for persistent cough, undetected COPD or asthma is frequently present.

BackgroundIn 2003 the Dutch Lung Cancer Information Centre (Longkanker Informatie Centrum) launched a website containing information on lung cancer accessible to anyone.ObjectiveOur study aim was to inventorize the information needs of the visitors of this website by analyzing the questions they asked the lung cancer specialists in the websites interactive section “Ask the Physician”.MethodsThe first 2000 questions posted up until May 2006 have been classified by visitors’ wish, type of required information, identity, gender, and phase during treatment course.ResultsOur results show that 1893 (1158/1893, 61%) of the questions were asked by a loved one/caregiver and (239/1893 13%) by patients. 1 out of 3 questions was asked by a daughter/grand-daughter. Most questions concerned specific information on lung cancer and lung cancer course (817/1893, 43%). The most inquired specific information topics were therapy side effects, diagnostics, general information on lung cancer, and regular therapy. Furthermore, questioners wanted to verify their own doctor’s information (122/1893, 6%), a diagnosis (267/1893, 14%), and a prognosis (204/1893, 11%).ConclusionsLung cancer patients and their caregivers asked the most questions in the interactive website section. The most frequently requested information was more detailed information. These include specific information on lung cancer (regular therapy, diagnostics, and disease symptoms), verification of what the doctor has said, diagnosis, and prognosis. Most of the requested information could have been obtained from treating specialists, indicating that current information supply to lung cancer patients and their caregivers may not be matching their needs sufficiently. The further implementation of an online dialogue with lung cancer specialists might be a solution.

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Bipolar electrocoagulation is one of the most important procedures in modern neurosurgery. However, there are still many practical problems, especially tissue adherence to the tips of the coagulating forceps and the difficulty removing carbonized clots from the tips. Both make the process less accurate and more time-consuming. To prevent formation of coagulum, recently, irrigation with a saline solution and coating of the forceps tips with a special metal have been tried. In this work, we compare a new bipolar electrocoagulator with automatic output control in relation to tissue impedance (Auto Suture - Valleylab NS 2000 with INSTANT RESPONSE technology) with a high-frequency coagulator (Erbotom ICC 350, Erbe). The femoral arteries and nerves of Wistar rats, weighing on average 360 g, were prepared and coagulation was carried out with variable power settings during a constant time (3 seconds). Sections were stained with haematoxylin-eosin, van Gieson and Luxol-Fast-Blue for histological examination. Coagulation with Erbotom ICC 350 resulted in tissue sticking to the tips of the forceps in all cases, regardless of the power chosen. With the new electrocoagulator, tissue adherence to the forceps tips was not seen. With the new system, effective coagulation was also achieved at comparably lower power settings.