A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection

Methods

We conducted a retrospective review of patients with pleural infection requiring intrapleural therapy at two tertiary referral centres.

Results

We included 84 (62.2%) and 51 (37.8%) patients who received sequential and concurrent intrapleural therapy, respectively. Patient demographics and clinical characteristics, including age, RAPID score, and percentage of pleural opacity on radiographs before intrapleural therapy, were similar in both groups. Treatment failure rates (defined by either in-hospital mortality, surgical intervention, or 30-day readmission for pleural infection) were 9.5% and 5.9% with sequential and concurrent intrapleural therapy, respectively (p = 0.534). This translates to a treatment success rate of 90.5% and 94.1% for sequential and concurrent intrapleural therapy, respectively. There was no significant difference in the decrease in percentage of pleural effusion size on chest radiographs (15.1% [IQR 6-35.7] versus 26.6% [IQR 9.9-38.7], p = 0.143) between sequential and concurrent therapy, respectively. There were also no significant differences in the rate of pleural bleeding (4.8% versus 9.8%, p = 0.298) and chest pain (13.1% versus 9.8%, p = 0.566) between sequential and concurrent therapy, respectively.

Conclusion

Our study adds to the growing literature on the safety and efficacy of concurrent intrapleural therapy in pleural infection.

Impact of structured curriculum with simulation on bronchoscopy

BACKGROUND AND OBJECTIVE

Simulation enhances a physician's competency in procedural skills by accelerating ascent of the learning curve. Training programmes are moving away from the Halstedian model of 'see one, do one, teach one', also referred as medical apprenticeship. We aimed to determine if a 3-month structured bronchoscopy curriculum that incorporated simulator training could improve bronchoscopy competency among pulmonary medicine trainees.

METHODS

We prospectively recruited trainees from hospitals with accredited pulmonary medicine programmes. Trainees from hospitals (A, B and C) were assigned to control group (CG) where they received training by traditional apprenticeship while trainees from hospital D were assigned to intervention group (IG) where they underwent 3-month structured curriculum that incorporated training with the bronchoscopy simulator. Two patient bronchoscopy procedures per trainee were recorded on video and scored independently by two expert bronchoscopists using the modified Bronchoscopy Skills and Tasks Assessment Tool (BSTAT) forms. A 25 multiple choice questions (MCQ) test was administered to all participants at the end of 3 months.

RESULTS

Eighteen trainees participated; 10 in CG and eight in IG with equal female:male ratio. Competency assessed by modified BSTAT and MCQ tests was variable and not driven by volume as IG performed fewer patient bronchoscopies but demonstrated better BSTAT, airway anaesthesia and MCQ scores. Bronchoscopy simulator training was the only factor that correlated with better BSTAT (r = 0.80), MCQ (r = 0.85) and airway anaesthesia scores (r = 0.83), and accelerated the learning curve of IG trainees.

CONCLUSION

An intensive 3-month structured bronchoscopy curriculum that incorporated simulator training led to improved cognitive and technical skill performance as compared with apprenticeship training.

Creating new supramolecular materials by architecture of three-dimensional nanocrystal fiber networks

The architecture of three-dimensional interconnecting self-organized nanofiber networks from separate needlelike crystals of L-DHL (lanosta-8,24-dien-3beta-ol:24,25-dihydrolanosterol = 56:44) in di-isooctylphthalate has been achieved for the first time, on the basis of the completely new concept of branching creation by additives (branching promoters). [In this work, an additive, ethylene/vinyl acetate copolymer (EVACP), is used at a concentration of several 10 ppm.] We demonstrate that this novel technique enables us to produce previously unknown self-supporting supramolecular functional materials with tailormade micro- or nanostructures, possessing significantly modified macroscopic properties, by utilizing materials thus far considered to be "useless". In addition, both the self-organized structure and the properties of the new materials can be fine-tuned by altering the processing conditions. Our results show that the formation of the interconnecting 3D self-organized network structure is controlled by a new mechanism, so-called crystallographic mismatch branching mechanism, as opposed to the conventionally adopted molecular self-assembly mechanism. The principles and criteria for the selection of branching promoters are also discussed from the point of view of molecular structures.