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Milano, Italy

Stigt J.A.,Isala Klinieken | Uil S.M.,Isala Klinieken | Denekamp M.,Medical Social Work | Shahin G.M.,Thoracic Surgery | Groen H.J.M.,University of Groningen
Journal of Thoracic Oncology | Year: 2013

INTRODUCTION: Little is known about the effects of rehabilitation for patients with lung cancer after thoracotomy. The primary objective of this study was to evaluate the effect of a multidisciplinary rehabilitation program on quality of life (QOL) and secondary objectives were to determine its effects on pain and exercise capacity and the feasibility of combining rehabilitation with adjuvant chemotherapy. METHODS: Patients who had undergone a thoracotomy for lung cancer were randomized between rehabilitation and usual care. Rehabilitation consisted of twice-weekly training for 12 weeks starting 1 month after hospital discharge, scheduled visits to pain specialists, and medical social work. QOL and pain were measured with validated questionnaires at baseline and after 1, 3, 6, and 12 months. Exercise tolerance was assessed at baseline and after 3 months with a 6-minute walking distance test. RESULTS: The study closed prematurely because of the introduction of video-assisted thoracoscopic surgery. Of 57 randomized patients, 49 patients (23 active and 26 control) were analyzed. QOL was not significantly different between groups, although, the active group reported more pain after 3 and 6 months and more limitations because of physical problems after 3 months. In the active group, 6-minute walking distance improved by 35 m from preoperative baseline, as opposed to the control group that showed a decline by 59 m (p = 0.024 for difference). Patients treated with adjuvant chemotherapy showed decreased attendance at training sessions. CONCLUSION: Rehabilitation did not result in a better QOL. Exercise tolerance improved at the cost of more pain and more limitations because of physical problems. We suggest that rehabilitation is better postponed for 3 to 4 months after hospital discharge. Copyright © 2012.

Myatt R.,Thoracic Surgery
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2014

Empyema is the term used to describe an accumulation of pus in a body cavity such as the pleural space as a result of bacterial infection. The condition is serious because it is difficult for the immune system to resolve infection in this area. Empyema can be avoided by the use of appropriate antibiotic therapy and good aseptic technique when dealing with any situation that breaches the chest wall. Treatment of this condition may be medical but if the condition does not resolve, surgical intervention is required. The nursing role involves providing support, education and long-term management for patients with empyema.

Myatt R.,Thoracic Surgery
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2014

Pleural effusions occur when fluid accumulates between the visceral and parietal pleura in the chest cavity, preventing the lung from expanding fully during inspiration. The reduction in lung volume, depression of the diaphragm and reduced chest wall compliance cause dyspnoea, and occasionally pain or cough. Pleural effusion is a complex problem caused by a variety of conditions requiring different treatment depending on the underlying diagnosis. This article discusses the causes and treatment of pleural effusions, referencing guidelines produced by the British Thoracic Society.

Block M.I.,Thoracic Surgery
Annals of Thoracic Surgery | Year: 2010

Background: No guidelines exist regarding the number of mediastinal lymph node stations that should be sampled to ensure adequate preoperative staging of lung cancer patients. In recent reports of esophageal endoscopic ultrasound and endobronchial ultrasound (EBUS), fewer than two stations/patient were sampled. An experience with systematic sampling using EBUS to determine how many stations should be sampled to adequately detect mediastinal disease was evaluated. Methods: Records were reviewed for all patients with lung cancer who had EBUS between March 9, 2006, and January 6, 2009. For each station sampled the sequence and result (positive, negative, and nondiagnostic) were recorded. For those with a positive biopsy, the sequence number of the first positive station was determined. The affect of systematic sampling on detection of N3 disease was also evaluated. Results: Ninety-three patients with non-small cell lung cancer had EBUS; 271 mediastinal stations were sampled (range, 0 to 6; mean, 2.9 per patient), with N3 and N2 stations sampled in 51 and 90 patients, respectively. Mediastinal disease was found in 25 patients; 15 patients had multistation N2 disease and 6 patients had N3 disease. In 15 patients (60%), mediastinal disease was detected in the first station sampled; three samples were required to detect 90% of disease, and the remaining 3 patients had their disease detected with the fourth sample. Conclusions: Introduction of EBUS as a tool for non-small cell lung cancer staging has led to a shift from systematic nodal sampling to targeted nodal sampling. These results indicate that systematic nodal sampling is feasible with EBUS, and that routinely sampling more than two mediastinal stations may improve staging. © 2010 The Society of Thoracic Surgeons.

Wertz M.S.,University of California at San Francisco | Kyriss T.,Thoracic Surgery | Paranjape S.,University of California at San Francisco | Glantz S.A.,University of California at San Francisco
PLoS Medicine | Year: 2011

Background: In 2009, the promulgation of US Food and Drug Administration (FDA) tobacco regulation focused attention on cigarette flavor additives. The tobacco industry had prepared for this eventuality by initiating a research program focusing on additive toxicity. The objective of this study was to analyze Philip Morris' Project MIX as a case study of tobacco industry scientific research being positioned strategically to prevent anticipated tobacco control regulations. Methods and Findings: We analyzed previously secret tobacco industry documents to identify internal strategies for research on cigarette additives and reanalyzed tobacco industry peer-reviewed published results of this research. We focused on the key group of studies conducted by Phillip Morris in a coordinated effort known as "Project MIX." Documents showed that Project MIX subsumed the study of various combinations of 333 cigarette additives. In addition to multiple internal reports, this work also led to four peer-reviewed publications (published in 2001). These papers concluded that there was no evidence of substantial toxicity attributable to the cigarette additives studied. Internal documents revealed post hoc changes in analytical protocols after initial statistical findings indicated an additive-associated increase in cigarette toxicity as well as increased total particulate matter (TPM) concentrations in additive-modified cigarette smoke. By expressing the data adjusted by TPM concentration, the published papers obscured this underlying toxicity and particulate increase. The animal toxicology results were based on a small number of rats in each experiment, raising the possibility that the failure to detect statistically significant changes in the end points was due to underpowering the experiments rather than lack of a real effect. Conclusion: The case study of Project MIX shows tobacco industry scientific research on the use of cigarette additives cannot be taken at face value. The results demonstrate that toxins in cigarette smoke increase substantially when additives are put in cigarettes, including the level of TPM. In particular, regulatory authorities, including the FDA and similar agencies elsewhere, could use the Project MIX data to eliminate the use of these 333 additives (including menthol) from cigarettes. © 2011 Wertz et al.

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