Nurses' perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study.

BACKGROUND AND AIM: Patient deaths are common in the intensive care unit, and a nurse's perception of barriers to and supportive behaviors in end-of-life care varies widely depending upon their cultural background. The aim of this study was to describe the perceptions of intensive care nurses regarding barriers to and supportive behaviors in providing end-of-life care in a Chinese cultural context. METHODS: A cross-sectional survey was conducted among intensive care nurses in 20 intensive care units in 11 general hospitals in central and eastern China. Instruments used in this study were general survey and Beckstrand's questionnaire. Data were collected via online survey platform. Descriptive analysis was used to describe general characteristics of participants and mean and standard deviations of the barriers and supportive behaviors. The mean and standard deviation were used to describe the intensity and frequency of each barrier or supportive behavior following Beckstrand's method to calculate the score of barriers and supportive behaviors. Content analysis was used to analyze the responses to open-ended questions. RESULTS: The response rate was 53% (n = 368/700). Five of the top six barriers related to families and the other was the nurse's lack of time. Supportive behaviors included three related to families and three related to healthcare providers. Nurses in the intensive care unit felt that families should be present at the bedside of a dying patient, there is a need to provide a quiet, independent environment and psychological support should be provided to the patient and family. Nurses believe that if possible, families can be given flexibility to visit dying patients, such as increasing the number of visits, rather than limiting visiting hours altogether. Families need to be given enough time to perform the final rites on the dying patient. Moreover, it is remarkable that nurses' supportive behaviors almost all concern care after death. CONCLUSIONS: According to ICU-nurses family-related factors, such as accompany of the dying patients and acceptence of patient's imminent death, were found the major factors affecting the quality of end-of-life care. These findings identify the most prominent current barriers and supportive behaviors, which may provide a basis for addressing these issues in the future to improve the quality of end-of-life care.

Advances in antitumor polysaccharides from phellinus sensu lato: Production, isolation, structure, antitumor activity, and mechanisms.

Edible and medicinal fungi (mushrooms) are widely applied to functional foods and nutraceutical products because of their proven nutritive and medicinal properties. Phellinus sensu lato is a well-known medicinal mushroom that has long been used in preventing ailments, including gastroenteric dysfunction, diarrhea, hemorrhage, and cancers, in oriental countries, particularly in China, Japan, and Korea. Polysaccharides represent a major class of bioactive molecules in Phellinus s. l., which have notable antitumor, immunomodulatory, and medicinal properties. Polysaccharides that were isolated from fruiting bodies, cultured mycelia, and filtrates of Phellinus s. l. have not only activated different immune responses of the host organism but have also directly suppressed tumor growth and metastasis. Studies suggest that polysaccharides from Phellinus s. l. are promising alternative anticancer agents or synergizers for existing antitumor drugs. This review summarizes the recent development of polysaccharides from Phellinus s. l., including polysaccharide production, extraction and isolation methods, chemical structure, antitumor activities, and mechanisms of action.

Structure and antioxidative property of a polysaccharide from an ammonium oxalate extract of Phellinus linteus.

In this paper, the novel polysaccharide PL-A11 was purified from an ammonium oxalate extract of Phellinus linteus mycelia. Its physicochemical properties, structural characteristics, and antioxidant activities were investigated. Results showed that PL-A11 had a weight-average molecular weight (Mw) of 13.8kDa and was mainly composed of arabinose, xylose, mannose, and glucose in a molar ratio of 1.1:1.3:1.0:6.6. The backbone of PL-A11 was composed of (1→4)-α-d-glucopyranosyl, (1→2)-α-d-xylopyranosyl, and (1→3)-α-d-arabinofuranosyl residues, whereas the (1→6)-α-d-mannopyranosyl residues formed branches at the O-2 position with 1-linked-α-d-glucopyranosyl terminal residues. From the antioxidative activity tests in vivo, the administration of PL-A11 obviously enhanced the activity of antioxidant enzymes and significantly reduced the level of malondiadehyde (MDA) in the serum and liver of d-galactose-treated aging mice in a dose-dependent manner, as well as effectively stimulated the immune system of aging mice. These findings implied that PL-A11 could be developed as a potential antioxidant for applications in the functional food, pharmaceutical, cosmetic or nutraceutical industries.

Structural features and antitumor activity of a novel polysaccharide from alkaline extract of Phellinus linteus mycelia.

A novel high molecular weight polysaccharide (PL-N1) was isolated from alkaline extract of the cultured Phellinus linteus mycelia. The weight average molecular weight (Mw) of PL-N1 was estimated at 343,000kDa. PL-N1 comprised arabinose, xylose, glucose, and galactose in the molar ratio of 4.0:6.7:1.3:1.0. The chemical structure of PL-N1 was investigated by FTIR and NMR spectroscopies and methylation analysis. The results showed that the backbone of PL-N1 comprised (1→4)-linked ß-D-xylopyranosyl residues, (1→2)-linked α-D-xylopyranosyl residues, (1→4)-linked α-D-glucopyranosyl residues, (1→5)-linked ß-D-arabinofuranosyl residues, (1→4)-linked ß-D-xylopyranosyl residues which branched at O-2, and (1→4)-linked ß-D-galactopyranosyl residues which branched at O-6. The branches consisted of (1→)-linked α-D-arabinofuranosyl residues. Antitumor activity assay in vitro showed that PL-N1 could inhibit the growth of HepG2 cells to a certain extent in a dose-dependent manner. Thus, PL-N1 may be developed as a potential, natural antitumor agent and functional food.

Effects of ultrasound on molecular properties, structure, chain conformation and degradation kinetics of carboxylic curdlan.

In this study, high-intensity ultrasound (20 kHz), a simple, effective and without any additive method, was used to the degradation of carboxylic curdlan (Cc) produced by 4-acetamido-TEMPO-mediated oxidation. The effects of ultrasound on molecular properties, structure and chain conformations of Cc were investigated by viscometry, size-exclusion chromatography with multiangle laser-light scattering (SEC-MALLS) analysis, as well as FTIR and NMR spectroscopies. The results indicated that the intrinsic viscosity [η] and the weight-average molecular weight (Mw) of Cc decreased obviously after ultrasound, and a uniform and narrow distribution of degradation product was obtained. The z-average radius of gyrations (Rg) firstly increased and then decreased as the sonication time prolonged. Ultrasound destroyed the hydrogen bonds resulting in the transition from compact random coil conformation to more flexible and even shorter extended chains. Ultrasonic treatment could not alter the primary chemical structure of Cc molecules according to the structural analysis by FTIR and NMR spectroscopies. Degradation kinetics based on Schmid model was applied to estimate the degradation rate constant k. It was found that the k value of Cc decreased with increasing the polymer concentration from 0.05 to 0.2% (w/v).

Self-aggregated nanoparticles of carboxylic curdlan-deoxycholic acid conjugates as a carrier of doxorubicin.

In this study, a new non-toxic, biodegradable, biocompatible and water-soluble carboxylic curdlan bearing the dissociable COOH group in 100% purity, which was prepared by 4-acetamido-TEMPO-mediated oxidation, was hydrophobically modified by deoxycholic acid (DOCA) to attain novel amphiphilic curdlan derivatives (CCDs) for the preparation of nano-carriers for antitumor drug doxorubicin (DOX). Under the effect of ultrasonication, the carboxylic curdlan derivatives in water were self-aggregated into spherical nanoparticles with diameters ranging from 214 nm to 380 nm. The critical aggregation concentrations decreased from 0.047 mg/mL to 0.016 mg/mL with increasing DS of DOCA. DOX-loaded CCD nanoparticles were prepared in an aqueous medium with dialysis method. The DOX-CCD nanoparticles exhibited pH- and dose-dependent drug release profiles during in vitro release experiments. Moreover, the drug transport mechanism was Fickian diffusion according to the Ritger-Peppas model. The CCD nanoparticles might be explored as potential carriers for hydrophobic drugs with controlled release and delivery functions.

Effect of extraction media on preliminary characterizations and antioxidant activities of Phellinus linteus polysaccharides.

Three partially purified polysaccharides were extracted from Phellinus linteus mycelia using hot water, 1% (NH4)2C2O4, and 1.25M NaOH/0.05% NaBH4, and the extracts were named PL-W, PL-A, and, PL-N respectively. PL-N mainly comprised xylose and arabinose with a high molecular weight (Mw) and the highest carbohydrate and uronic acid contents. PL-W and PL-A were mainly composed of glucose with high and low Mw fractions in various ratios. All three polysaccharides existed as compact coils in aqueous solutions and exhibited strong scavenging capacity and antioxidant activities in a concentration-dependent manner. The polysaccharides also had high uronic acid and carbohydrate contents and strong antioxidant activities. The Mws, monosaccharide compositions, and chemical structures of the polysaccharides also affected their antioxidant activities. PL-A and PL-N had better antioxidant activities and could thus be developed as potential natural antioxidant agents for applications in food additives and biomedical industries.