Fluorescence and thermal imaging of non-melanoma skin cancers before and during photodynamic therapy.

BACKGROUND: Photodynamic therapy (PDT) has been shown to be less effective on the extremities. Protoporphyrin-IX (PpIX) fluorescence and skin surface temperature are variables that have been implicated in the differences in efficacy with body site, but objective studies have not been undertaken. OBJECTIVES: To further investigate observations from our previous study that temperature and fluorescence during pro-drug incubation are correlated, through a prospective objective investigation of the relationships between fluorescence and skin surface temperature before and during PDT and relationships with body site and efficacy. METHODS: Eighteen patients with Bowen's disease or basal cell carcinoma, who had been referred for PDT, were recruited to this study. PpIX fluorescence and thermal measurements were recorded at intervals during the pro-drug incubation and irradiation phases of PDT. Pain immediately after irradiation, and outcome at 3- and 12-months were recorded. RESULTS: Temperature and PpIX fluorescence were higher on the trunk than lower leg immediately before treatment (median temperature 32.7 °C vs. 27.8 °C, p < 0.05 and median fluorescence 16.5 vs. 6.7, p < 0.05). Higher pain levels were reported during PDT on the extremities (median 5.7 vs. 2.2, p < 0.05). Clearance rates at 12-months were 80 %. CONCLUSIONS: The study supports a correlation between temperature and PpIX fluorescence during PDT, providing robust objective data to support our previous hypothesis and observations. The higher pain levels, lower PpIX fluorescence on the lower leg, and the high efficacy rates at all body sites irrespective of temperature and fluorescence indicates that relationships between PDT treatment conditions and parameters is likely to be multifactorial.

Use of illuminance as a guide to effective light delivery during daylight photodynamic therapy in the U.K.

BACKGROUND: Daylight PDT (dPDT) is an effective and nearly painless treatment for field-change actinic keratosis. Measuring the protoporphyrin-IX (PpIX)-weighted exposure dose can give an indication of when conditions are most viable for effective dPDT. It would be advantageous for practitioners if more detailed information of exposure dose and appropriate treatment conditions were available. Where sophisticated measurement equipment is unavailable, simpler and more cost-effective methods of dose measurement are desirable. OBJECTIVES: To devise a model whereby illuminance data can be converted into PpIX-weighted exposure dose, and to use this model to estimate appropriate times for dPDT across the U.K. and Ireland. METHODS: Spectral irradiance data were analysed to obtain a conversion model for illuminance to PpIX-weighted dose. This model was applied to historic illuminance data from nine sites to obtain PpIX-weighted dose across the U.K. and Ireland. Temperature data and an analysis of conservatory-based dPDT were also considered. RESULTS: Distribution of the expected PpIX-weighted dose across the nine locations is presented. Temperature data showed that it could be too cold for dPDT, even when there is sufficient light exposure. Conservatory-based dPDT could extend the times in the year for possible treatment. CONCLUSIONS: This proposed conversion model provides a means of using an illuminance reading to calculate the PpIX-weighted exposure dose. Dosimetry of dPDT may be carried out simply and at low cost using the presented method; however, the results presented may be used as a guide for those considering dPDT, without the need to conduct measurements themselves.

Imaging for Quality Control: Comparison of Systematic Video Recording to the Operative Note in Colorectal Cancer Surgery. A Pilot Study.

BACKGROUND: Oncological and functional results after colorectal cancer surgery vary considerably between hospitals and surgeons. At present, the only source of technical information about the surgical procedure is the operative note, which is subjective and omits critical information. This study aimed to evaluate the feasibility of operative video recording in demonstrating both objective information concerning the surgical procedure and surgical quality, as using a systematic approach might improve surgical performance. METHODS: From July 2015 through November 2015, patients aged ≥18 years undergoing elective colorectal cancer surgery were prospectively included in a single-institution trial. Video recording of key moments was performed peroperatively and analyzed for adequacy. The study cases were compared with a historic cohort. Video was compared with the operative note using the amount of adequate steps and a scoring system. RESULTS: This study compared 15 cases to 32 cases from the historic control group. Compared to the written operative note alone, significant differences in availability of information were seen in favor of video as well as using a combination of video plus the operative note (N adequate steps p = .024; p = <.001. Adequacy score: p = .039; p = <.001, both respectively). CONCLUSIONS: Systematic video registration is feasible and seems to improve the availability of essential information after colorectal cancer surgery. In this respect, combining video with a traditional operative note would be the best option. A multicenter international study is being organized to further evaluate the effect of operative video capture on surgical outcomes.

High rate of maternal vitamin B12 deficiency nearly a decade after Canadian folic acid flour fortification.

Vitamin B12 deficiency may be an independent risk factor for neural tube defects (NTD). We determined the prevalence of biochemical B12 deficiency (<125 pmol/l) among 10 622 Ontarian women aged 15-46 years who underwent concomitant testing of serum bhCG and B12 9 years after the implementation of Canadian folic acid flour fortification. The overall prevalence of biochemical B12 deficiency was 7.4%. Relative to non-pregnant women, the adjusted odds ratio (95% confidence interval) of biochemical B12 deficiency was 0.78 (0.60-1.0) among women pregnant 28 days gestation or less and was 1.4 (1.1-1.8) after 28 days gestation. About 1 in 20 women may be deficient in B12 in early pregnancy. The impact on maternal and fetal well-being, including preventable NTD, should be considered.

Certified nurse-midwifery care of the postpartum client. A descriptive study.

This article presents the findings of a small, descriptive, exploratory study aimed at identifying the content and process components of certified nurse-midwifery care in the postpartum period. The conceptual framework, methods, and analysis were derived from the research of E.J. Lehrman, who identified components of CNM antepartum care. Lehrman's components of prenatal care were all found to be present in the postpartum period, but new data emerged. These data generated three distinctively new categories, ie, therapeutic techniques, lateral relationship, and empowerment. Albeit from a small study, our findings support previous research suggesting aspects of CNM care that might be partially responsible for improved perinatal outcome documented in various populations where CNM care has been established. The article concludes with a discussion of these implications for practice and the need for further definition of the profession of nurse-midwifery.