An open pilot study of ambulatory photodynamic therapy using a wearable low-irradiance organic light-emitting diode light source in the treatment of nonmelanoma skin cancer

Background Photodynamic therapy (PDT) is a popular treatment for nonmelanoma skin cancer with clearance rates of between 70% and 100%. Although reported to have a superior cosmetic outcome, the inconvenience of hospital visits and discomfort during therapy are considered drawbacks. Objectives To present an open pilot study of a low‐irradiance, potentially disposable, lightweight, organic light‐emitting diode (OLED), which is an area‐emitting light source (2 cm diameter), suitable for ambulatory PDT. Methods Twelve patients with Bowen’s disease (eight) and superficial basal cell carcinoma (four) < 2 cm in diameter were recruited into the study following histological confirmation of the diagnosis. Two treatments (45–60 J cm^?2 red light, 550–750 nm, peak 620 nm, irradiance 5 mW cm^?2) were administered 1 month apart following application of aminolaevulinic acid for 4 h. Results At the 12‐month follow‐up, seven of the 12 patients remained clear, with four of the nonresponders demonstrating peripheral margin failure. Patients were scored for pain during and immediately after treatment using the numerical rating scale (NRS; 1–10). All 12 subjects scored pain as < 2 using the NRS (median score 1). In contrast, a similar cohort of 50 consecutive patients from our routine PDT clinic (Aktilite^® inorganic LED source; 75 J cm^?2, irradiance 80 mW cm^?2) scored a median of 6 on the NRS. Conclusions Pain and inconvenience are practical barriers to the use of conventional PDT. This pilot study suggests that OLED‐PDT is less painful than conventional PDT with the added advantage of being lightweight, and therefore has the potential for more convenient ‘home PDT’. These results need to be validated in larger studies.     

Improving evidence‐based practice in rehabilitation: Introducing PsycBITETM

Background: Clinicians face significant obstacles in their access to evidence for the efficacy of different communicative and cognitive treatments after brain impairment. These include the need to search across diverse journals and different clinical conditions to find potential treatments and the lack of easily accessible standards by which to evaluate the methodological rigour of treatment studies once found.

Aims: We aimed to address these issues by developing a freely available, user‐friendly database of all relevant treatment trials for psychologically based disorders that arise from brain impairment.

Methods & Procedures: PsycBITE^TM (http://www.psycbite.com) was developed as an internet‐based database and was officially launched in 2004. Included on PsycBITE^TM are all trials that have been published that evaluate treatment for any communication, cognitive, or psychological disorder arising from any form of acquired brain impairment in children (above the age of 5 years) and adults. PsycBITE^TM also provides a rating for the methodological rigour of each trial using the previously established PEDro scale (Maher, Sherrington, Herbert, Moseley, & Elkins, 2003 Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M. and Elkins, M. 2003. Reliability of the PEDro scale for rating quality of randomized controlled trials.. Physical Therapy, 83: 713–721. [PubMed], [Web of Science ®] , [Google Scholar]) for randomised controlled trials (RCT) and non‐RCT group comparisons. A PsycBITE^TM rating scale for single case experimental studies is still under development. This report overviews the database, its contents, and the methodology by which papers are selected for inclusion.

Outcomes & Results: As of June 2005 there are 1167 treatment studies listed on PsycBITE^TM with prospective searches being conducted on a regular basis. The highest proportion of studies report treatments for communication disorders followed by behavioural problems and memory. Ratings of the randomised controlled trials, group comparisons, and single case studies are available for a proportion of papers and are being updated continuously.

Conclusions: PsycBITE^TM is an invaluable resource for clinicians and researchers interested in an evidence‐based practice approach to treatment. It is a free, fast, and effective way of accessing and evaluating treatments for communicative and cognitive disorders following brain impairment.     

Measuring African-American parents' cultural mistrust while in a healthcare setting: a pilot study

BACKGROUND: African Americans' mistrust of healthcare is often cited as a cause of racial disparities in health and has been linked to cultural mistrust. African-American parents' level of cultural mistrust while in a general healthcare setting has not been previously measured. OBJECTIVE: To determine the performance, participant acceptance, feasibility of administration and demographic associations of a measure of cultural mistrust, the Cultural Mistrust Inventory (CMI), in African-American parents seeking healthcare. METHODS: A cross-sectional sample of 69 self-identified African-American parents of minor children recruited in a university-affiliated, urban pediatric/family practice outpatient clinic completed an anonymous, self-administered questionnaire containing demographic items and the CMI. RESULTS: The response rate was 91% (n=63), and 49 (78%) -- answered all questions. Measured mistrust did not vary with gender, insurance or education. The CMI's internal consistency was similar to previously published studies of the instrument (alpha=0.92). Parents indicating discomfort with the CMI's questions reported significantly less mistrust than parents who did not indicate discomfort (p=0.01). CONCLUSIONS: The CMI is feasible to administer in a clinic setting and demonstrates good internal consistency. It can be a useful tool to assess the effect of cultural mistrust on the healthcare decisions African-American parents make for their children. However, when measuring cultural mistrust in a healthcare setting, respondents' comfort with the survey questions should be assessed.