Novel light delivery method for performing transbronchial photodynamic therapy ablation to treat peripheral lung cancer: A pilot study.

BACKGROUND: Photodynamic therapy involves using a photosensitizer with l illumination and is recommended for treating early, centrally located lung cancers, but it is not a standard treatment for peripheral lung tumor.. We previously proposed a novel light delivery method, in which lipiodol is perfused into the bronchial tree to increase the scope of illumination via the fiber effect. Herein, we attempted this novel technique under electromagnetic bronchoscope guidance in a hybrid operation room where lipiodol facilitated light diffusion, and evaluated the effectiveness and feasibility of this technique for peripheral lung cancers. METHODS: This phase 0 pilot study included three patients with peripheral lung cancers (primary tumors ≤20-mm diameter). The photodynamic therapy was administered using Porfimer sodium as the photosensitizer, and an electromagnetic navigation bronchoscope in a hybrid operating room to guide the catheter to the tumor. This facilitated lipiodol infusion to encase the tumor and permit the transbronchial photodynamic therapy ablation. RESULTS: Administering 630 nm 200 J/cm (400mW/500sec) energy through a 3-cm cylindrical diffusing laser fiber was safe; no significant acute complications were observed. Although the treatment outcome was unsatisfactory due to the low light dose, tumor pathology in one case revealed tumor necrosis, with no significant damage to the surrounding lung tissue. CONCLUSIONS: Novel light delivery transbronchial photodynamic therapy ablation for peripheral lung tumors is feasible and safe. Additional clinical trials may help determine the best illumination plan and light dose through multiple deliveries from multiple angles.

Impact of Inspiratory Muscle Training on Weaning Parameters in Prolonged Ventilator-Dependent Patients: A Preliminary Study.

Introduction: Patients require prolonged mechanical ventilation to overcome respiratory failure in the chronic respiratory care ward; however, how to facilitate ventilator weaning using a nurse-led strategy is limited. Objectives: This study aimed to examine the impact of adjusting ventilator trigger sensitivity as inspiratory muscle training on weaning parameters in patients with prolonged ventilator dependence. Methods: Multiple pre-test-post-test with a non-equivalent control group design was conducted at a chronic respiratory care ward in southern Taiwan. A convenience sampling method was used to recruit patients who received prolonged mechanical ventilation for more than 21 days into control (n = 20) and intervention groups (n = 22). Adjustment of ventilator trigger sensitivity started from 10% of the initial maximum inspiratory pressure and increased to 40% after a training period of six weeks. The weaning parameters were collected for pre-test and multiple post-tests, and statistical analysis of treatment effects was performed using the generalized estimating equation. Results: Magnitude of weaning parameters was significantly higher in the intervention group after the six-week training, including maximum inspiratory pressure, rapid shallow breathing index, tidal volume, and ratio of arterial-to-inspired oxygen. Conclusion: Adjustment of ventilator trigger sensitivity as inspiratory muscle training can help prolonged ventilator-dependent patients improve their respiratory muscle strength, breathing patterns, and oxygenation.

Development of the Benefit-Risk Assessment of Complementary and Alternative Medicine Use in People With Diabetes: A Delphi-Analytic Hierarchy Process Approach.

This study aimed to develop consensus on a decision-making algorithm for benefit-risk assessment of complementary and alternative medicine use in people with diabetes. Delphi-analytic hierarchy process was used with an anonymous voting scheme, based on a three-round procedure, to achieve consensus regarding the important criteria of decision-making algorithm to assess the benefit-risk ratio of complementary and alternative medicine use in people with diabetes. A total of five criteria were considered, namely, the safety of usage (weightage: 46.6%), diabetes-specific patient data (14.6%), complementary and alternative medicine attributes (14.2%), institutional culture in complementary and alternative medicine use (12.8%), and applicability of complementary and alternative medicine (11.8%). The consistency of this hierarchy structure was computed based on the following indices: λmax = 5.041, consistency index = 0.01; random consistency index =1.781; and consistency ratio = 0.009. All criteria to optimize decision-making in ensuring safe use of complementary and alternative medicine in patients with diabetes should be considered by healthcare professionals.

A virtual simulation-based educational application about complementary and alternative medicine: A pilot study of nurses' attitudes and communication competency.

BACKGROUND: Conventional healthcare professionals have insufficient knowledge about complementary/alternative medicine (CAM) and often lack competencies to overcome attitudinal barriers to communicate effectively with patients about CAM. Interacting with a virtual simulation-based educational application program may help nurses learn current evidence and acquire communication skills when consulting with patients. OBJECTIVES: The aim of this pilot study was to evaluate nurses' attitudes towards patients' CAM use and their competency in communicating with patients about CAM after interacting with a virtual simulation-based educational app. DESIGN: A quasi-experimental study with one-group, pretest-posttest design. METHODS: A total of 49 nurses volunteered to participate in the study. Participants interacted with a virtual simulation software app on a smartphone that included audiovisual presentations about CAM, 13 exercises, and a risk-benefit decision assessment. Data about nurses' attitudes and communication competency were collected at baseline and after completing the 13 exercises. Descriptive and comparative statistics were analyzed using the IBM® SPSS® version 22.0. RESULTS: Both the nurses' attitudes about patients' CAM use and communication competency improved significantly following the completion of the 13 exercises. The risk-benefit decision scores correlated significantly with the increase in nurses' attitudes and their communication competency. CONCLUSIONS: Using a virtual simulation-based educational app may help nurses not only increase their attitudes towards CAM but also increase their communication competency in consulting with patients about CAM use.

Bronchoscopic light delivery method for peripheral lung cancer photodynamic therapy.

BACKGROUND: Trans-bronchoscope treatment for early stage small peripheral lung cancer, such as photodynamic therapy (PDT), has been investigated. However, despite the efficacy of PDT, light delivery issues limit its application. A method of administering mineral oil with a high refractive index (RI) was previously proposed to enhance light delivery in branched or bent anatomic structures. Lipiodol has a high RI and an exhaustive history of use as a contrast medium for bronchography. We aimed to determine whether the use of lipiodol, like mineral oil, could enhance the illumination effect and therapeutic range of PDT for peripheral lung tumors. METHODS: We injected lipiodol into a pig lung model, guided by a bronchoscope under fluorescent surveillance, to simulate future treatment in humans, and then illuminated with PDT laser fiber to the lipiodol-infused lung to test the technique feasibility in a pig orally administered 20 mg/kg of 5-aminolevulinicc acid (5-ALA) 2 hours before treatment. We also attempted to determine the maximal tolerable light dose in this pilot study for the future studies in human. RESULTS: We successfully injected lipiodol into peripheral lungs by this technique. The pig could tolerate up to a total of 40 mL of lipiodol and 800 J of red light, without severe acute fetal injury in a non-cancerous lung. CONCLUSIONS: The technique of injecting lipiodol using bronchoscopy under fluorescent guidance was feasible in a pig model. We can apply the guide sheath through bronchoscopy under fluoroscope inspection. Lipiodol can be used as a light diffuser for the peripheral lung tumor PDT model. No severe lethal acute lung injury was caused by this PDT model under careful manipulation. Additional studies evaluating the dose correlation of the photosensitizer and light are needed.