No abstract

OBJECTIVES: Minimally invasive video-assisted thoracic surgery (VATS) was first introduced in the early 1990s. For decades, numerous non-randomized studies demonstrated advantages of VATS over thoracotomy with lower morbidity and shorter hospital stay, but only recently did a randomized trial document that VATS results in lower pain scores and better quality of life. Opposing arguments for VATS have always been increased costs and concerns about oncological adequacy. In this paper, we aim to investigate the cost-effectiveness of VATS. METHODS: The study was designed as a cost–utility analysis of the first 12 months following surgery and was performed together with a clinical randomized controlled trial of VATS versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year period (2008–2014). All health-related expenses were retrieved from a national database (Statistics Denmark) including hospital readmissions, outpatient clinic visits, prescription medication costs, consultations with general practitioners, specialists, physiotherapists, psychologists and chiropractors. RESULTS: One hundred and three VATS patients and 103 thoracotomy patients were randomized. Mean costs per patient operated by VATS were 103 108 Danish Kroner (Dkr) (€13 818) and 134 945 Dkr (€18 085) by thoracotomy, making the costs for VATS 31 837 Dkr (€4267) lower than thoracotomy (P < 0.001). The difference in quality-adjusted life years gained over 52 weeks of follow-up was 0.021 (P = 0.048, 95% confidence interval −0.04 to −0.00015) in favour of VATS. The median duration of the surgical procedure was shorter after thoracotomy (79 vs 100 min; P < 0.001). The mean length of hospitalization was shorter following VATS (4.8 vs 6.7 days; P = 0.027). The use of other resources was not significantly different between groups. The costs of resources were lower in the VATS group. This difference was primarily due to reduced costs of readmissions (VATS 29 247 Dkr vs thoracotomy 51 734 Dkr; P < 0.001) and costs of outpatient visits (VATS 51 412 Dkr vs thoracotomy 61 575 Dkr; P = 0.012). CONCLUSIONS: VATS is a cost-effective alternative to thoracotomy following lobectomy for stage 1 lung cancer. Economical outcomes as measured by quality-adjusted life years were significantly better and overall costs were lower for VATS. Clinical Trial Registration Number: NCT01278888.

N Nu ur rs se e--c co on nd du uc ct te ed d s sm mo ok ki in ng g c ce es ss sa at ti io on n w wi it th h m mi in ni im ma al l i in nt te er r--v ve en nt ti io on n i in n a a l lu un ng g c cl li in ni ic c: : a a r ra an nd do om mi iz ze ed d c co on nt tr ro ol ll le ed d s st tu ud dy y Subjects who smoked less than 10 cigarettes·day -1 , and subjects who smoked ≥10 cigarettes·day -1 and who had refused to participate in a smoking cessation trial with nicotine replacement therapy, were randomly allocated to a motivational approach to smoking cessation or to a control group. The motivational approach consisted of a nurse-conducted 5 min consultation concerning reasons to quit smoking, brochures about smoking cessation and advice about how to quit. After 4-6 weeks, subjects in the motivational group received a letter encouraging them to quit smoking. After 1 year, all subjects were contacted by phone and smoking status reported. Subjects claiming to be abstinent attended the clinic for carbon monoxide verification.A total of 507 subjects were enrolled, 254 in the motivational group and 253 in the control group. The mean age of the motivational group was 51 yrs, 50% were males and they smoked a mean of 13 cigarettes·day -1 . The mean age of the control group was 53 yrs, 61% were males and they smoked a mean of 12 cigarettes·day -1 . At the 1 year follow-up, the success rate for point prevalence (no smoking at 1 year and during the preceding month) was 8, 7% in the motivational group versus 3.6% in the control group (p=0.025). The 12 months sustained success rate (no smoking at all during the year) was 3.1 versus 1.2% (p=0.22). The point prevalence for light smokers (<10 cigarettes·day -1 ) was 13.9% in the motivational group versus 6.3% in control group (p=0.12), and for heavy smokers (10 or more cigarettes·day -1 ) 5.2% versus 1.9% (p=0.20).In conclusion, the effect of this nurse-conducted, minimal intervention, motivational approach seems promising as the quit rate at 1 year follow-up had doubled.

Background: Thoracic ultrasound (TUS) has a high diagnostic accuracy for many common pulmonary diseases, but theoretic knowledge in sonographic physics, thoracic anatomy and physiology, and sonopathologic patterns is required to develop competence. Objectives: The aims of the study were to develop and gather validity evidence for a theoretical test in TUS and to establish a pass/fail standard. Methods: Content was provided based on expert interviews, leading to creation of 113 initial multiple-choice (MCQ) items. Consensus was reached on 92 proceeding items through a Delphiprocess, and items were presented to physicians with different knowledge and experience in TUS. Answers were used for item statistics in order to select the items with the most optimal item discrimination and difficulty (i.e. Level 1 items) to be included in the final test. Mean scores of the novice-, intermediate-and experienced group were compared, and a pass/fail score was established using the contrasting groups' standard setting method. Results: Item statistic revealed 38 Level 1 items, of which 30 were selected to be included in the final test. The internal consistency was high (Cronbach's alpha =0.88). Differences in mean scores were 8.6 points (p<0.001), 6.3 points (p=0.01), and 14.0 points (p<0.001) between novices and intermediates, intermediates and experienced, and novices and experienced, respectively. A pass/fail standard of 20 points was established. Conclusion: The established MCQ-test can distinguish between physicians with different level of competence in TUS, and enables an objective, evidence-based approach for assessing the theoretical knowledge for trainees undergoing an educational program in TUS.

No abstract