Chlorin e6 and BLZ945 Based Self-Assembly for Photodynamic Immunotherapy Through Immunogenic Tumor Induction and Tumor-Associated Macrophage Depletion.

Immunotherapeutic effect is restricted by the nonimmunogenic tumor phenotype and immunosuppression behaviors of tumor-associated macrophages (TAMs). In this work, a drug self-assembly (designated as CeBLZ) is fabricated based on chlorin e6 (Ce6) and BLZ945 to activate photodynamic immunotherapy through tumor immunogenic induction and tumor-associated macrophage depletion. It is found that Ce6 tends to assemble with BLZ945 without any drug excipients, which can enhance the cellular uptake, tumor penetration, and blood circulation behaviors. The robust photodynamic therapy effect of CeBLZ efficiently suppresses the primary tumor growth and also triggers immunogenic cell death to reverse the nonimmunogenic tumor phenotype. Moreover, CeBLZ can deplete TAMs in tumor tissues to reverse the immunosuppression microenvironment, activating abscopal effect for distant tumor inhibition. In vitro and in vivo results confirm the superior antitumor effect of CeBLZ with negligible side effect, which might promote the development of sophisticated drug combinations for systematic tumor management.

[Excelling in the AI Era: Cultivating AI Literacy].

In light of the rapid advancements in artificial intelligence (AI), the future of the nursing profession is expected to be closely intertwined with AI applications. In response to this challenge, nursing educators must cultivate AI literacy in students to ensure their ability to communicate and collaborate effectively with their interdisciplinary peers. Nursing educators should comprehend the essence of AI literacy, integrate AI literacy into their curriculum designs, and regularly assess the effectiveness of AI literacy cultivation efforts among their students to ensure nursing graduates are able to effectively fulfill their roles in nursing and healthcare. The purpose of this paper is to explain the essence of AI literacy, approaches for cultivating AI literacy in students, and methods for assessing AI literacy with the aim of educating nursing students to become competent nurses for tomorrow.

Standardized patients' experiences of portraying characters in difficult communication scenarios: Narrative inquiry.

BACKGROUND: There are limited studies that explored the preparation and challenges faced by standardized patients (SPs) in portraying characters in difficult communication scenarios, and the strategies used to overcome these challenges. The purpose of this study was to understand the experience of SPs in interpreting difficult communication situations and the learning needs of performing similar scenarios. And it allows the researchers to explore the meaning, beliefs, values, and aspiration associated with their role as SPs. The findings could shade light on the significance of their experiences and provide valuable insights for the development of future SP training programs. METHODS: The design of this study is framed by a narrative inquiry, using semi-structured guidelines to conduct in-depth interviews with 11 SPs who have participated in the performances of difficult communication situations. Research data were analyzed by Polkinghorne narrative analysis, and Riessman's four criteria were used to establish rigor. RESULTS: Analysis revealed the following five themes: scenarios to real life connections, process of preparing for a performance, methods to detach from character, obtaining unexpected rewards, and needs for performance training. There are two to three subthemes that are subsumed under each theme. CONCLUSIONS: To strengthen training in difficult communication for healthcare professionals, the use of SPs to interpret challenging difficult communication scenarios will continue to increase. Educators need to ensure that SPs are fully prepared physically and emotionally before, during and after their performance. Offering of continuing education and training in feedback techniques are crucial to extend the tenure of SPs, reduce their frustration, prevent attrition, and ultimately, reduce training costs. In the future, SP training should also include detachment and feedback techniques to alleviate SPs' stress.

Chemotherapy-Enabled Colorectal Cancer Immunotherapy of Self-Delivery Nano-PROTACs by Inhibiting Tumor Glycolysis and Avoiding Adaptive Immune Resistance.

The chemo-regulation abilities of chemotherapeutic medications are appealing to address the low immunogenicity, immunosuppressive lactate microenvironment, and adaptive immune resistance of colorectal cancer. In this work, the proteolysis targeting chimera (PROTAC) of BRD4 (dBET57) is found to downregulate colorectal cancer glycolysis through the transcription inhibition of c-Myc, which also inhibits the expression of programmed death ligand 1 (PD-L1) to reverse immune evasion and avoid adaptive immune resistance. Based on this, self-delivery nano-PROTACs (designated as DdLD NPs) are further fabricated by the self-assembly of doxorubicin (DOX) and dBET57 with the assistance of DSPE-PEG2000. DdLD NPs can improve the stability, intracellular delivery, and tumor targeting accumulation of DOX and dBET57. Meanwhile, the chemotherapeutic effect of DdLD NPs can efficiently destroy colorectal cancer cells to trigger a robust immunogenic cell death (ICD). More importantly, the chemo-regulation effects of DdLD NPs can inhibit colorectal cancer glycolysis to reduce the lactate production, and downregulate the PD-L1 expression through BRD4 degradation. Taking advantages of the chemotherapy and chemo-regulation ability, DdLD NPs systemically activated the antitumor immunity to suppress the primary and metastatic colorectal cancer progression without inducing any systemic side effects. Such self-delivery nano-PROTACs may provide a new insight for chemotherapy-enabled tumor immunotherapy.

Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit.

AIM: The purpose of this study was to evaluate the effectiveness of ECMO care board games facilitated teaching approach (ECMO care board games) in enhancing ECMO care knowledge, clinical reasoning and learning engagement among intensive care unit (ICU) nurses. BACKGROUND: ECMO is a highly complex, relatively low-incidence, high-risk clinical life support device system used in the intensive care unit (ICU). Its usage has increased nearly tenfold over the past 30 years. Traditionally, ECMO education has been delivered through classroom teaching, which has demonstrated limited effectiveness in promoting nurses' learning engagement, clinical reasoning competency and confidence. The literature suggests that well-designed board games can enhance learning engagement, stimulate higher-level thinking and improve the effectiveness and confidence of nurses' learning. DESIGN: A quasi-experimental study two-group repeated measure design. METHODS: A purposive sample of 73 ICU nurses from two campuses of one medical center was recruited (37 in the experimental group and 36 in the control group). The experimental group received ECMO care training through ECMO care board games facilitated teaching approach, whereas the control group completed the training through a traditional teaching approach. Instruments used for data collection include a demographic information sheet, ECMO Care Knowledge Scale, Clinical Reasoning Scale (Huang et al., 2023) and Learning Engagement Scale (Ciou , 2020). Both groups completed a pre-test before the training, a post-test one week after the training and a second post-test three weeks after the training. RESULTS: Prior to the intervention, there were no significant differences between the two groups in ECMO care knowledge and learning engagement. However, there was a significant difference in clinical reasoning. One week after the intervention, the experimental group demonstrated significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement than the control group (p <0.01). Three weeks after the intervention, the experimental group showed significantly higher scores in ECMO care knowledge, clinical reasoning and learning engagement (p <0.001). CONCLUSIONS: The content for ECMO care is complex and difficult. Board games can enhance ECMO care knowledge, clinical reasoning and learning engagement. This teaching strategy may be applied to learning challenging subjects in the future to improve learning effectiveness. The clinical reasoning framework is conducive to guiding nurses' learning. In future continuing education, board games designed based on the clinical reasoning framework and tailored to the focus of in-service education can effectively enhance nurses' learning effectiveness.

Application of the Ohio Nurse Competency Model in a BSN Leadership/Management Course.

ABSTRACT: Strategically preparing students to meet practice expectations is a priority for nursing educators. The Ohio Nurse Competency Model (ONCM) was applied as the organizing framework for a senior baccalaureate leadership/management course. The purpose of this pretest/posttest descriptive study was to evaluate changes in students' confidence in understanding, applying, and valuing the ONCM. Paired t -tests found statistically significant increases in confidence levels for all ONCM competencies among 56 students with greatest increases in systems-based practice and informatics and technology. Nurse educators are encouraged to intentionally structure and organize course content and curricula according to state and national competency models/guidelines.

Chimeric Peptide-Engineered Self-Delivery Nanomedicine for Photodynamic-Triggered Breast Cancer Immunotherapy by Macrophage Polarization.

A systemic treatment strategy is urgently demanded to suppress the rapid growth and easy metastasis characteristics of breast cancer. In this work, a chimeric peptide-engineered self-delivery nanomedicine (designated as ChiP-CeR) for photodynamic-triggered breast cancer immunotherapy by macrophage polarization. Among these, ChiP-CeR is composed of the photosensitizer of chlorine e6 (Ce6) and the TLR7/8 agonist of lmiquimod (R837), which is further modified with tumor matrix targeting peptide (Fmoc-K(Fmoc)-PEG8 -CREKA. ChiP-CeR is preferred to actively accumulate at the tumor site via specific recognition of fibronectin, which can eradicate primary tumor growth through photodynamic therapy (PDT). Meanwhile, the destruction of primary tumors would trigger immunogenic cell death (ICD) effects to release high-mobility group box-1(HMGB1) and expose calreticulin (CRT). Moreover, ChiP-CeR can also polarize M2-type tumor-associated macrophages (TAMs) into M1-type TAMs, which can activate T cell antitumor immunity in combination with ICD. Overall, ChiP-CeR possesses superior antitumor effects against primary and lung metastatic tumors, which provide an applicable nanomedicine and a feasible strategy for the systemic management of metastatic breast cancer.

[Development and Validation of the Outpatient Nurses Communication Behavior Inventory].

BACKGROUND: Outpatient clinics in medical centers are the most common location where people seek medical treatment. Because they must provide patients with treatment information in a timely manner, good communication skills are a key competency for outpatient nurses. However, the tools available for communication behavior assessment are general and rarely tailored for outpatient settings. PURPOSE: The purpose was to develop a communication behavior inventory for outpatient nurses and to examine its reliability and validity. METHODS: During phase one, the authors conducted a literature search and synthesis, using the findings to develop the Outpatient Nurses Communication Behavior Inventory. During phase two, two expert validation rounds were conducted to confirm content validity. During phase three, 220 licensed outpatient nurses were recruited from a medical center in northern Taiwan to complete the instrument (December 2018 - January 2019.) The construct validity and internal consistency of the inventory were evaluated. RESULTS: The literature search and synthesis identified six domains of communication, including connect, introduce, communicate, ask, respond, and exit. A total of 25 items were generated. Following the two expert panel validation rounds, the six domains remained but the inventory items were reduced to 21. Both item-content validity index and scale-level content validity index were 1.0. In phase three, the results of the confirmatory factor analysis retained six factors with a total of 16 items. Model three showed that the inventory demonstrated goodness of fit (Χ ² = 155.75, p < .001, RMSEA = .06, GFI = .92, AGFI = .87, NNFI = .97, NFI = .95, Model AIC = 253.75). Internal consistency was demonstrated with a Cronbach's α of .89. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The Outpatient Nurses Communication Behavior Inventory exhibits good reliability and validity and may be used to assess outpatient nurses' communication behaviors and as a basis for education. The six CICARE (connect, introduce, communicate, ask, respond and exit) domains may be utilized to remind outpatient nurses to demonstrate effective communication consistently, promote outpatient nurses' communication with patients, and improve quality of care.

Carrier-Free Nano-PROTACs to Amplify Photodynamic Therapy Induced DNA Damage through BRD4 Degradation.

Therapy-induced DNA damage is the most common strategy to inhibit tumor cell proliferation, but the therapeutic efficacy is limited by DNA repair machinery. Carrier-free nanoproteolysis targeting chimeras (PROTACs), designed as SDNpros, have been developed to enhance photodynamic therapy (PDT) by blocking the DNA damage repair pathway through BRD4 degradation. Specifically, SDNpros are constructed through noncovalent interactions between the photosensitizer of chlorine e6 (Ce6) and PROTACs of BRD4 degrader (dBET57) via self-assembly. SDNpro has favorable dispersibility and a uniform nanosize distribution without drug excipients. Upon light irradiation, SDNpro produces abundant reactive oxygen species (ROS) to induce DNA oxidative damage. Meanwhile, the DNA repair pathway would be interrupted by the concurrent degradation of BRD4, which could intensify the oxidative DNA damage and elevate PDT efficiency. Beneficially, SDNpro suppresses tumor growth and avoids systemic side effects, providing a promising strategy to promote the clinical translation of PROTACs for tumor treatment.

Paraptosis Inducer to Effectively Trigger Immunogenic Cell Death for Metastatic Tumor Immunotherapy with IDO Inhibition.

Paraptosis is characterized by the extensive vacuolization of endoplasmic reticulum (ER) and mitochondria, which will cause the release of damage-associated molecular patterns to promote immunogenic cell death (ICD). However, the tumor can develop an immunosuppressive microenvironment to affect the ICD activation for the purpose of immune escape. Herein, a paraptosis inducer (CMN) is constructed to amplify the ICD effect for efficient immunotherapy by inhibiting the activity of indoleamine 2,3-dioxygenase (IDO). Initially, CMN is prepared by the assembly of copper ions (Cu2+), morusin (MR), and IDO inhibitor (NLG919) through noncovalent interactions. Without the need for extra drug carriers, CMN possesses very high drug contents and exhibits a favorable GSH responsiveness for disassembly. Subsequently, the released MR can trigger paraptosis to cause extensive vacuolization of ER and mitochondria, contributing to activating ICD for immunotherapy. Moreover, NLG919 would inhibit IDO to remodel the tumor microenvironment and promote the activation of cytotoxic T cells, leading to an intensive antitumor immunity. Abundant in vivo studies indicate that CMN is superior in suppressing the proliferations of not only primary tumor but also metastatic and rechallenged tumors. Such a GSH-responsive paraptosis inducer might provide a promising strategy to trigger ICD and enhance tumor immunotherapy.

Development and Psychometric Testing of the Clinical Reasoning Scale Among Nursing Students Enrolled in Three Types of Programs in Taiwan.

BACKGROUND: There is no instrument currently available to assess the essential nursing competency of clinical reasoning (CR). PURPOSE: The purpose of this study was to develop and test the psychometric properties of CR assessment instrument appropriate for use with nursing students across different types of programs. METHODS: H. M. Huang et al.'s (2018) Framework of Competencies of Clinical Reasoning for Nursing Students was used to guide this study. Two rounds of Delphi study and confirmatory factor analysis (CFA) were conducted to test content and construct validity. Internal consistency was tested for reliability. RESULTS: The four-domain, 16-item Likert-scale Clinical Reasoning Scale (CRS) was developed. One thousand five hundred four nursing students currently enrolled in three different types of nursing programs completed the CRS. The content validity index was .85-1.0, the CFA indicated goodness of fit, and the Cronbach's α score range was .78-.89. CONCLUSION: The CRS is a valid and reliable tool for assessing CR in nursing students in different types of nursing program.

Self-delivery biomedicine for enhanced photodynamic therapy by feedback promotion of tumor autophagy.

Reactive oxygen species (ROS) generated during photodynamic therapy (PDT) can induce autophagy to protect tumor cell from PDT-induced apoptosis. In this work, a self-delivery autophagy regulator (designated as CeCe) is developed for autophagy promotion sensitized PDT against tumor. Briefly, CeCe is prepared by the assembly of a photosensitizer of chlorin e6 (Ce6) and autophagy promoter of celastrol. By virtue of intermolecular interactions, Ce6 and celastrol are able to self-assemble into nanomedicine with great photodynamic performance and autophagy regulation capacity. Under light irradiation, CeCe would produce ROS in tumor cells to amplify the oxidative stress and promote cell autophagy. As a result, CeCe exhibits an enhanced photo toxicity by inducing autophagic cell death. In vivo experiments indicate that CeCe can predominantly accumulate in tumor tissue for a robust PDT. Moreover, CeCe has a superior therapeutic efficiency compared to monotherapy and combined treatment of Ce6 and celastrol, suggesting a synergistic antitumor effect of PDT and autophagy promotion. This self-delivery nanomedicine may advance the development of the co-delivery nanoplatform to improve the antitumor efficacy of PDT by promoting autophagy. STATEMENT OF SIGNIFICANCE: Autophagy is a "double-edged sword" in cellular homeostasis and metabolism, which can promote tumor progression but also induce an unknown impact on tumor inhibition. In this work, a self-delivery autophagy regulator (designated as CeCe) was developed for autophagy promotion sensitized photodynamic therapy (PDT). By virtue of intermolecular interactions, Ce6 and celastrol were found to self-assemble into stable CeCe without drug excipients, which exhibited great photodynamic performance and autophagy regulation capacity. In vitro and in vivo findings demonstrated a superior tumor suppression ability of CeCe over the monotherapy as well as the combined treatment of Ce6 and celastrol, suggesting a synergistic antitumor efficacy by PDT and autophagy promotion.

Cascade Immune Activation of Self-Delivery Biomedicine for Photodynamic Immunotherapy Against Metastatic Tumor.

Photodynamic therapy (PDT) can generate reactive oxygen species (ROS) to cause cell apoptosis and induce immunogenic cell death (ICD) to activate immune response, becoming a promising antitumor modality. However, the overexpressions of indoleamine 2,3-dioxygenase (IDO) and programmed cell death ligand 1 (PD-L1) on tumor cells would reduce cytotoxic T cells infiltration and inhibit the immune activation. In this paper, a simple but effective nanosystem is developed to solve these issues for enhanced photodynamic immunotherapy. Specifically, it has been constructed a self-delivery biomedicine (CeNB) based on photosensitizer chlorine e6 (Ce6), IDO inhibitor (NLG919), and PD1/PDL1 blocker (BMS-1) without the need for extra excipients. Of note, CeNB possesses fairly high drug content (nearly 100%), favorable stability, and uniform morphology. More importantly, CeNB-mediated IDO inhibition and PD1/PDL1 blockade greatly improve the immunosuppressive tumor microenvironments to promote immune activation. The PDT of CeNB not only inhibits tumor proliferation but also induces ICD response to activate immunological cascade. Ultimately, self-delivery CeNB tremendously suppresses the tumor growth and metastasis while leads to a minimized side effect. Such simple and effective antitumor strategy overcomes the therapeutic resistance against PDT-initiated immunotherapy, suggesting a potential for metastatic tumor treatment in clinic.

Effectiveness of the virtual reality chemical disaster training program in emergency nurses: A quasi experimental study.

BACKGROUND: In Taiwan, 50 % of the chemical disasters in the last decade were industrial accidents. The leakage of industrial toxic chemical substances may cause significant environmental pollution and harms. Taiwan's chemical disaster education and training mainly rely on simulation, which is labor-intensive, time-consuming, and costly. Tabletop drills are often used to as a substitute for simulations. However, tabletop drills lack a realistic presence. The 360° virtual reality (VR) transforms knowledge of disaster preparedness into audio-visual and other sensory experiences and allows participants to be physically immersed in an environment. PURPOSE: This study examined effectiveness of a "360° VR chemical disaster training program" on disaster preparedness and self-efficacy in ER nurses. METHOD: This study used convenience sampling and quasi-experimental design with two-group repeated measures. Seventy-seven ER nurses were recruited with the experimental group (n = 32) receiving chemical disaster training through 360° VR and the control group (n = 35) receiving training through tabletop drills. Data were collected before, one week after and three weeks after the intervention. RESULT: Participants in the experimental group were significantly younger and less experienced in disaster management than those in the control group. There were no between-group differences in the participants' self-assessment of chemical disaster preparedness and self-efficacy before the intervention. The intervention group showed significantly higher self-assessment chemical disaster preparedness scores than the comparison group (p < .05) one week after the intervention. However, no significant differences were found three weeks after the intervention. CONCLUSION: This study found that both 360° VR and tabletop drills improved preparedness and self-efficacy in chemical disasters among ER nurses. VR could be used for disaster preparedness training for nurses without prior disaster response experiences/ drills, whereas tabletop drills were more suitable for nurses with prior experiences. Both methods may effectively promote nurses' learning effectiveness and self-efficacy in chemical disaster preparedness.

Photodynamic Therapy Initiated Ferrotherapy of Self-Delivery Nanomedicine to Amplify Lipid Peroxidation via GPX4 Inactivation.

Lipid peroxide (LPO) is the hallmark of ferroptosis, which is a promising antitumor modality for its unique advantages. However, a cellular defense system would weaken the antitumor efficacy of ferrotherapy. Herein, a GPX4 inhibitor of ML162 and a photosensitizer of chlorine e6 (Ce6) are used to prepare the self-delivery nanomedicine (C-ML162) through hydrophobic and electrostatic interactions to enhance ferroptosis by photodynamic therapy (PDT). Specifically, carrier-free C-ML162 improves the solubility, stability, and cellular uptake of antitumor agents. Upon light irradiation, the internalized C-ML162 generates large amounts of reactive oxygen species (ROS) to oxidize cellular unsaturated lipid into LPO. More importantly, C-ML162 can directly inactivate GPX4 to enhance the accumulation of toxic LPO, inducing ferroptotic cell death. Additionally, C-ML162 is capable of accumulating at a tumor site for effective treatment. This self-delivery system to amplify lipid peroxidation via GPX4 inactivation for PDT initiated ferrotherapy might provide an appealing strategy against malignancies.

Effectiveness of e-STORY App in clinical reasoning competency and self-directed learning among students in associate nursing program: A quasi experimental study.

AIM: The purpose of this study was to promote students' clinical reasoning (CR) and self-directed learning (SDL). The specific aims were: (1) to examine effectiveness of the e-STORY App in promoting nursing students' CR and SDL; and (2) to explore the relationships between levels of learning motivation and suitability of the e-STORY App. BACKGROUND: CR and SDL are core competencies for nursing students. However, new graduates tend to be in adequately prepared in these competencies. Humanoid diagram uses diagrams to guide students in gaining a comprehensive view of the patient issues, which may promote attainment of these competencies. The Z generation students favor learning through smart devices for the feature of no time and spatial limitations. The e-STORY App was developed to overcome the setbacks of creating hard-copy drawings to promote learning effectiveness. DESIGN: This quasi-experimental study used two-group repeated measure design with a convenience sample. METHODS: A total of 77 students from two sections of the "Seminar for Clinical Case Studies" course participated in the study (experimental group: 39 students; control group: 38 students). Data were collected before, one week after and four weeks after the teaching intervention. The instruments used were demographic information sheet, Huang et al.'s (in press) Clinical reasoning scale and Cheng et al. (2010) Self-directed learning instrument. RESULTS: There were no significant differences in the CR and SDL scores between the experimental and control groups one week after the intervention (p＞.05). Analyses of the delay effects four weeks after the intervention found significantly higher CR scores in the experimental group than the control group (p < .05). However, there were no significant differences in the SDL scores between groups (p＞.05). Analysis of the findings from the experimental group found that students with moderate and low learning motivation showed significantly higher CR scores on the posttest and follow-up test (p < .05). CONCLUSIONS: Application of the e-STORY App as a supplementary teaching strategy promoted nursing students' CR ability, especially in students with moderate or low learning motivation. It is recommended to use the App in students with moderate or low learning motivation to promote learning effectiveness.

Valproic Acid Enhances Radiosensitization via DNA Double-strand Breaks for Boronophenylalanine-mediated Neutron Capture Therapy in Melanoma Cells.

BACKGROUND: Boron neutron capture therapy (BNCT) is a radiotherapeutic approach that can destroy cancer cells while sparing the surrounding normal cells. Currently, boronophenylalanine (BPA) is the most common boron delivery agent used in BNCT for treating recurrent cancers of the head and neck, gliomas, and melanomas. On the other hand, valproic acid (VPA) is one of the representative class I histone deacetylase inhibitors (HDACi), which is a promising sensitizer for cancer therapies. In this study, we aimed to verify whether VPA could induce an enhanced effect in destroying melanoma cells in concurrence with BNCT and to explore the underlying mechanism of VPA-BNCT action in killing these cells. MATERIALS AND METHODS: Murine melanoma B16-F10 cells were pre-treated with VPA and irradiated with neutron during BPA-BNCT. We explored the clonogenic assay and the expression of phosphorylated H2AX (γH2AX) for cell survival and DNA double-strand breaks (DSBs), respectively. We also examined the expression levels of DNA damage responses-associated proteins and performed a cell cycle analysis. RESULTS: Our data indicated that the combination treatment of VPA and BNCT could significantly inhibit the growth of melanoma cells. Furthermore, VPA-BNCT treatment could exacerbate and perturb DNA DSBs in B16-F10 cells. In addition, pre-treatment of VPA abolished the G2/M arrest checkpoint caused by BNCT. CONCLUSION: Our results demonstrate that VPA has the potential to serve as a radiosensitizer of BPA-mediated BNCT for melanoma. These findings could improve BNCT treatments for melanoma.

Effectiveness of a Mobile Technology-Supported Self-Reflective Course in Communication Behaviors for Outpatient Nurses.

Background Communication is a core competency for outpatient nurses. This study investigated the effectiveness of a mobile technology-supported self-reflective (MTS) course in communication behaviors among outpatient nurses. Method This quasi-experimental study used a convenience sample of 78 outpatient nurses (experimental group = 39; control group = 39). The experimental group completed the MTS communication course. Communication behaviors were evaluated before, 1 week after, and 1 month after the course. Results There was no significant difference in communication behaviors between the groups before the intervention. One week after the intervention, communication behavior scores significantly increased in both groups without significant between-group differences (p > .05). One month after the intervention, the experimental group showed significantly higher communication behavior scores (p < .05). Both groups demonstrated high learning satisfaction. Conclusion The MTS communication course was successful in promoting effective outpatient nurse-patient communication. Health care facilities may want to incorporate the MTS course into their orientation program. [J Contin Educ Nurs. 2022;53(6):279-288.].

Self-Delivery Ternary Bioregulators for Photodynamic Amplified Immunotherapy by Tumor Microenvironment Reprogramming.

Abnormal metabolism of cancer cells results in complex tumor microenvironments (TME), which play a dominant role in tumor metastasis. Herein, self-delivery ternary bioregulators (designated as TerBio) are constructed for photodynamic amplified immunotherapy against colorectal cancer by TME reprogramming. Specifically, carrier-free TerBio are prepared by the self-assembly of chlorine e6, SB505124 (SB), and lonidamine (Lon), which exhibit improved tumor accumulation, tumor penetration, and cellular uptake behaviors. Interestingly, TerBio-mediated photodynamic therapy (PDT) could not only inhibit the primary tumor growth but also induce immunogenic cell death of tumors to activate the cascade immune response. Furthermore, TerBio are capable of TME reprograming by SB-triggered transforming growth factor (TGF)-ß blockage and Lon-induced lactic acid efflux inhibition. As a consequence, TerBio significantly suppresses distant and metastatic tumor growth by PDT-amplified immunotherapy. This study might advance the development of self-delivery nanomedicine against malignant tumor growth and metastasis.