Progress in the treatment of pulmonary metastases after liver transplantation for hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the fifth most common cancer in the world, and is the third leading cause of cancer-related death. Liver transplantation(LT) has become a curative treatment for patients with HCC. However, recurrence and metastasis after LT are the main factors reducing long-term survival in patients, and the lung is the most common site of metastasis after LT for HCC, although metastasis to liver, para-aortic lymph nodes and renal periphery are observed. Thus, the treatment of pulmonary metastases after LT for HCC has become a hot research topic, the successful treatment of pulmonary metastases can significantly prolong the survival of LT patients. Although single conventional treatment(chemotherapy, surgery and external beam radiation therapy), immunosuppression, image-guided minimally invasive therapy(radiofrequency ablation, microwave ablation, cryoablation, and brachytherapy) and molecular targeted drugs have had a significant effect, patients do not have durable remission and the long-term survival rate is disappointing. Therefore, improving existing treatments and identifying a more effective combination therapy are important research issues in the prevention and treatment of pulmonary metastases after LT for HCC. The paper reviewed single conventional treatments, new treatments, and combination therapy, to provide a basis for the best treatment of these patients.

The general public’s ability to operate automated external defi brillator: A controlled simulation study

BACKGROUND:Automated external defibrillators(AEDs)enable laypeople to provide early defi brillations to patients undergoing cardiac arrest,but scant information is available on the general public’s ability to use AEDs.This study assessed the ability of laypeople to operate AEDs,the effect of a 15-minute training,and whether skills differed by age.METHODS:From May 1 to December 31,2018,a prospective simulation study was conducted with 94 laypeople aged 18–65 years(32 aged 18–24 years,34 aged 25–54 years,and 28 aged 55–65 years)with no prior AED training.The participants’AED skills were assessed individually pretraining,post-training,and at a three-month follow-up using a simulated cardiac arrest scenario.The critical actions and time intervals were evaluated during the AED operating process.RESULTS:Only 14(14.9%)participants(eight aged 18–24 years,four aged 25–54 years,and two aged 55–65 years)successfully delivered defi brillations before training.AED operation errors were more likely to occur among the participants aged 55–65 years than among other age groups.After training,the proportion of successful defi brillations increased signifi cantly(18–24 years old:25.0%vs.71.9%,P<0.01;25–54 years old:11.8%vs.70.6%,P<0.01;55–65 years old:7.1%vs.67.9%,P<0.01).After three months,26.1%of the participants aged 55–65 years successfully delivered defi brillations,which was signifi cantly lower than that of participants aged 18–24 years(54.8%)and 25–54 years(64.3%)(P=0.02).There were no differences in time measures among three age groups in each test.CONCLUSIONS:The majority of untrained laypeople cannot effectively operate AEDs.More frequent training and refresher courses are crucial to improve AED skills.

Effects of hospital–community integrated transitional care on quality of life in patients with chronic obstructive pulmonary disease

Objective: To explore the effects of “hospital–community integrated transitional care” model on quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 117 inpatients with COPD from the Department of Respiratory Medicine in a tertiary general hospital in Nanjing were enrolled by convenience sampling from January to December in 2016 and then were divided into intervention group (n = 60) and control group (n = 57) by random number table. Patients in the intervention group accepted both routine care and hospital– community integrated transitional care for 3 months after discharge. Assessment of quality of life by telephone follow-up or interview within a week before discharge and 1, 3, and 6 months after discharge was evaluated using the Short Form-36 (SF-36) health survey questionnaire. Results: For a total score of quality of life, there was a significant difference between the two groups (P < 0.05): 1, 3, and 6 months after discharge. In addition, for each dimension score of quality of life, there were no significant differences (P > 0.05) except vitality dimension, 1 month after discharge, and there were significant differences in all dimensions, 3 and 6 months after discharge (P < 0.05) Conclusions: Hospital–community integrated transitional care model can improve the quality of life of patients with COPD.

Resilience in new nurses:a qualitative study

Objectives:To explore the resilience experience of new nurses and how new nurses develop and apply resilience strategies to cope with the difficulties during the transition period.Methods:A descriptive qualitative research method was on data acquired using data semi-structured interviews with 12 new nurses aged 20-26 years whose working time was more than 12 months but less than 24 months.Results:Analysis of the data could determine participants adopting resilience strategies to withstand difficulties and challenges in transition period.This period consisted of three main phases:"self-protection,""undertaking challenges,"and"planning future."The first-line nurse managers'feedback and flexible shift scheduling paid a vital part in promoting the resilience development of new nurses.Conclusions:Recognizing the importance of understanding and developing the resilience of new nurses in the transition period could greatly reduce the turnover rate and alleviate the shortage of nurses in global nursing workforce.

Article History Investigation and analysis of the quality of life of centenarians in Chongming area of Shanghai

Objective:To investigate the status quo and influencing factors of the quality of life of the elderly aged≥100 years old in Chongming area of Shanghai,and provide a basis for the construction of a world-class ecological island in Chongming area and promote the cause of healthy aging.Methods:A cross-sectional survey was conducted to screen 71 elderly people who were 100 years old and reached the age of 100.The interview was conducted with a face-to-face questionnaire survey.Results:The SF-36 health questionnaire of the centenarians in Chongming area scored and in the physiological functions,physiological functions,physical pain,general health status,energy,social function,emotional function and mental health is(36.35±13.45),(36.62±38.69),(62.56±21.57),(47.04±6.06),(67.23±18.76),(71.83±25.85),(60.09±45.29),(78.70±22.20).The total physical health assessment and mental health assessment scores are(181.577±50.271)and(277.855±81.636).Univariate statistics show that different genders,education levels,marital status,economic sources,urban or rural areas,insurance categories,chronic diseases,number of children,old-age patterns,preferred forms of residence,interval between child care,and whether children are in the same city Factors such as≥2 in the family,long-term diet,diet,eating habits,drinking habits,tea drinking habits,physical examination,lack of sleep 4h,nap habits and other factors in the different dimensions of the SF-36 scale,the difference is statistically significant(P<0.05);multivariate stepwise regression showed that the relevant influencing factors were pension mode,dietary preference,location(urban/rural),chronic disease,preferred lifestyle,lack of sleep 4 h,education level,marital status(P<0.05).Conclusion:The centenarians in Chongming area have a medium quality of life rating and a high overall mental health assessment.The centenarians in Chongming have a good psychological state.The life behavior pattern of the centenarians is worth learning.It is recommended to implement the family mutual aid public service project to alleviate the problem of loneliness of the elderly.It is recommended to strengthen the chronic disease health management for the elderly,encourage regular medical examinations,and promote the improvement of the old-age care.

Management of early mobilization in intensive care units:a multicenter cross-sectional study

Objective: The aim of this study was to assess the management of early mobilization(EM) in Chinese intensive care units(ICUs).Methods: This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.Results: We identified 69 ICUs in Jiangsu, China(response rate: 94.2%). 74.2%(1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1%(1,327) reported use of in-bed exercise, 5.7%(77) sitting on a side of bed, 21.7%(294) transfer to chair, and 2.4%(33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions: Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.