Tumor-derived extracellular vesicle drug delivery system for chemo-photothermal-immune combination cancer treatment.

Tumor extracellular vesicles (EVs) demonstrate considerable promise for medication delivery and tumor targeting owing to their natural long-term blood circulation and tissue targeting capabilities. We extracted EVs from mouse breast cancer cell 4T1 using UV stimulation and differential centrifugation. To create a new nano-drug delivery system, the vesicle delivery system (EPM) loaded with melanin and paclitaxel albumin (PA), the collected EVs were repeatedly compressed on a 200 nm porous polycarbonate membrane with melanin and PA. Our findings suggest that EPM is readily absorbed by breast cancer and dendritic cells. EPM generates significant photoacoustic signals and photothermal effects when exposed to near-infrared light and can enhance the infiltration of CD8+ T cells in mouse tumor tissues. EPM is more cytotoxic than PA in in vivo and in vitro investigations. The efficacy of EPM in clinical transformation when paired with chemotherapy/photothermal/immunotherapy treatment is demonstrated in this study.

Symptom clusters and their predictors in patients with lung cancer and treated with programmed cell death protein 1 immunotherapy.

Objective: The aims of this study were to examine the symptom severity and interference among patients with lung cancer treated with PD-1 immunotherapy, explore whether those symptoms were clustered together, and identify factors associated with symptom clusters. Methods: A cross-sectional study was conducted. Data were collected by demographic and clinical characteristic questionnaires and the M.D. Anderson Symptom Inventory Lung Cancer Module. Symptom clusters were identified using exploratory factor analysis, and stepwise linear regression was applied to analyze the factors affecting the symptom clusters. Results: A total of 148 patients with lung cancer treated with PD-1 immunotherapy participated in this study. The overall symptom burdens of these patients were mainly at a mild level. The patient symptom clusters identified in this study were a general cluster, a treatment-related cluster, a pulmonary cluster, a gastrointestinal cluster, and a neural cluster. The patients' Karnofsky performance status (KPS) score (ߠ​= â€‹-2.758, P â€‹< â€‹0.001) and having a history of chemotherapy (ߠ​= â€‹4.384, P â€‹= â€‹0.001) were significant predictors of the general cluster. Their KPS scores (ߠ​= â€‹-1.202, P â€‹< â€‹0.001) and having a history of chemotherapy (ߠ​= â€‹-1.957, P â€‹= â€‹0.001) were significant predictors of the pulmonary cluster. Their monthly income (ߠ​= â€‹-0.316, P â€‹= â€‹0.030) and KPS scores (ߠ​= â€‹-0.357, P â€‹= â€‹0.045) were significant predictors of the gastrointestinal cluster. Having a history of chemotherapy (ߠ​= â€‹1.868, P â€‹< â€‹0.001) was the predictor of the neural cluster. Conclusions: The symptom burdens of patients with lung cancer and treated with PD-1 immunotherapy were at a mild level and appeared to be clustered. In addition, because the symptoms that comprise a cluster are interrelated, the diagnosis and management of each symptom in a cluster should not be performed in isolation, and each symptom in a cluster should be treated either simultaneously or in an orderly manner.

Work readiness: Its determinants and association with work-related outcomes among new graduate nurses.

AIMS: This study aimed to identify determinants of work readiness and to assess the influences of work readiness on work-related outcomes in graduate nurses. BACKGROUND: Higher work readiness facilitates smoother role transitions of new graduate nurses. However, determinants of work readiness had not been fully examined. In addition, the relationships between work readiness and work-related outcomes, such as coping self-efficacy and occupational commitment, are also crucial but had not been assessed. METHODS: We recruited 794 graduate nurses and assessed their work readiness before working as nurses. After they commenced their work, we assessed their occupational commitment, coping self-efficacy and intention to remain. All assessments were conducted online. RESULTS: There were 728 (92%) female respondents. The mean scores and standard deviation (SD) of work readiness, coping self-efficacy, occupational commitment and intention to remain were 261.51 (SD: 45.40), 30.30 (SD: 6.13), 81.65 (SD: 11.56) and 11.01 (SD: 2.36), respectively. Based on a regression analysis, determinants of work readiness were positive school climate, student leadership experience, nursing as the primary choice of discipline and perceived influences of COVID-19 on the honorability of being a nurse and the willingness to be a nurse (p < .001). Moreover, after adjusted by all demographics and characteristics variables, higher work readiness would result in higher coping self-efficacy (estimated coefficient = 0.06, p < .001), occupational commitment (estimated coefficient = 0.06, p < .001) and intention to remain (estimated coefficient = 0.01, p = .002). CONCLUSION: Work readiness is a composite concept affected by psychosocial and environmental factors, which can predict new graduate nurses' future self-efficacy, occupational commitment and intention to remain. IMPLICATIONS FOR NURSING MANAGEMENT: The management of new graduate nurses when they begin to work could target their work readiness. Transition programmes that consider our identified determinants can be provided to those who show lower work readiness.

Appetite loss, death anxiety and medical coping modes in COVID-19 patients: a cross-sectional study.

AIM: This study aims to explore the current level and associated factors of appetite and death anxiety amongst COVID-19 patients and also to identify correlation between the two variables. DESIGN: A cross-sectional study. METHODS: Demographic and characteristic questionnaires, templer death anxiety scale, council on nutrition of appetite questionnaire and medical coping modes questionnaire were utilized. RESULTS: The average scores of appetite and death anxiety were 19.46 (4.09) and 6.58, (3.21) respectively. 76 patients (100%) suffered from appetite loss, whilst 27 (35.50%) patients suffered from severe death anxiety. Marital status, COVID-19 disease condition ranks, educational level and death anxiety were explained 55.20% of the total variance in the appetite regression model (F = 31.83, p < .001), whilst the gender, avoidance coping strategy and appetite level were explained 49.80% of the total variance in death anxiety model (F = 17.80, p < .001). A moderate negative correlation between appetite and death anxiety was also confirmed (r=-.55, p < .001).

Management of a COVID-19-infected critically ill patient treated by extracorporeal membrane oxygenation: a case report.

Coronavirus disease 2019 (COVID-19) is a new type of respiratory infectious disease that spreads among humans. People infected with COVID-19 present with severe acute respiratory symptoms, fever, cough, breathlessness and dyspnea, impaired physical conditions, kidney failure, and even death. Chest radiographs suggest diffuse inflammation in both lungs and show "white lung" changes. Patients may even experience multiple organ failures within a short period. The effects of general ventilator-assisted treatment are poor. While the application of extracorporeal membrane oxygenation (ECMO) for adjuvant therapy in COVID-19 patients may benefit, there is still a lack of clinical management experience to guide the treatment of the disease. Therefore, in this case, report, we describe the case of a COVID-19-infected patient who was managed with ECMO. During treatment, the patient's vital signs, biochemical indicators, and hemodynamic changes were closely monitored, with strengthening the operation of ECMO and mechanical ventilation, the patients bleeding, infection and other related complications were actively prevented and managed. After active treatment and careful management, the patient was successfully weaned from ECMO after 13 days. This report has summarized the management experience of a severe case with ECMO management, which can provide a reference for the diagnosis and treatment of severe COVID-19 patients in the future.

Intention to response, emergency preparedness and intention to leave among nurses during COVID-19.

AIM: To comprehensively assess the current level and identify associated factors of intention to response and emergency preparedness of clinical nurses during COVID-19 outbreak. DESIGN: A cross-sectional study was designed. METHODS: Demographic and characteristic questionnaire, intention to response scale, emergency preparedness scale and a self-designed questionnaire related to effects of events and intention to leave were used in this study. RESULTS: The mean scores of intention to response and emergency preparedness were 82.00 (SD = 18.17) and 64.99 (SD = 12.94), respectively. Moral consideration, engaged in COVID-19 protection training, had working experience in SARS, and the other eight factors were explained 34.6% of the total model variance in intention to response model (F = 80.05, p < .001). While, the level of IR, whether the pace of work was affected and above three same factors were explained 21.5% of the total model variance (F = 91.05, p < .001). Pathway analysis revealed that moral consideration, intention to leave and impacts on work and life mediate the relationship between EP and IR.

Psychometric properties assessment of Chinese version of work readiness scale for graduate nurses (WRS-GN) and associated factors of work readiness: Two cross-sectional studies.

BACKGROUND: Lower work readiness is tied to anxiety, high turnover and nurse transition failure. An assessment of work readiness is necessary. To date, no relative scale exists in China. Thus, a work readiness related scale is urgently needed. OBJECTIVES: To assess the psychometric properties of the scale, and look into the status of Chinese graduate nurse work readiness and factors associated with work readiness. DESIGN, SETTINGS, AND PARTICIPANTS: Both psychometric assessment and associated factors are designed with cross-sectional studies. 832 and 435 graduate nurses were recruited in the above two studies, respectively. METHODS: Brislin's transition model was utilized for the transition process, and a six-expert panel and preliminary survey were conducted for face validity and testing the transition version respectively. Exploratory factor analysis, confirmatory factor analysis, internal consistency reliability and test-retest reliability were applied for reliability and validity testing. Additionally, a linear regression method was carried out for analyzing influencing factors of work readiness of graduate nurses across China. RESULTS: A 37-item Chinese version scale was proven to have great psychometric qualities. Five factors were extracted by exploratory factor analysis, which can explain 68.637% of the total variance. Furthermore, the confirmatory factor analysis demonstrates the fit indices of a five factors mode: X2/df = 1.769, RMSEA = 0.067, NFI = 0.859, RFI = 0.839, IFI = 0.934, CFI = 0.933, TLI = 0.923. Intra-class correlation coefficient, Cronbach's α and Guttman Split-half were 0.805, 0.960 and 0.903, respectively. Interpersonal relationships, leadership experience, scholarship, work experience and willingness to be nurses were associated with the potential to achieve higher work readiness. CONCLUSION: The Chinese version of WRS-GN with good validity and reliability can be utilized for assessment of work readiness. Besides, improving work readiness of graduate nurses based on above five associated factors, educators and hospital managers could help graduate nurses having a smooth transition for a stable nursing workforce.