Clinical Simulation Augments Traditional Interviewing of Advanced Practice Provider Candidates

An essential role of critical care advanced practice providers—advanced practice registered nurses and physician assistants—is to have knowledge and competency to make accurate and efficient decisions. The ability to manage clinical scenarios involving medically deteriorating patients requires higher-order cognitive thinking and leadership skills that are challenging to extrapolate in traditional interviews. In critical care, advanced practice providers must make rapid clinical assessments and implement appropriate medical interventions to deter progression of life-threatening illnesses. Adding clinical simulation to the traditional interview allows interviewers to evaluate applicants’ crisis resource management skills, leadership, and clinical competency.     

An Interdisciplinary Collaboration for Environmental Education

Climate change education in advanced practice registered nursing curricula prepares nurse practitioners to respond to the health effects of climate change. Knowledge of the relationship between human and environmental health is essential for nurse practitioners to identify, teach, and respond to the health effects of climate change in clinical and community settings. This article describes a webinar hosted by the Sarah P. Duke Gardens in partnership with the Duke University School of Nursing. Our webinar provided an opportunity for attendees to understand how gardening can mitigate climate change, the important relationship between human and environmental health, and nurses’ role in climate crisis.     

Assessing Southeastern Advanced Practice Registered Nurses’ Business and Operational Skill Sets

As advanced practice registered nurses (APRNs) open private practices in medically underserved areas, clinical, practice management, and business skills are needed conjunctively to remain operational. Further information is needed to understand APRN business and entrepreneurial skill needs. A convenience sample assessed perceptions of confidence in business and operational skill sets needed for entrepreneurial roles in 102 APRNs, representing diversity of subspecialties and practice locations in 4 southeastern states with provider shortages: Alabama, Florida, Mississippi, and Tennessee. Sustaining practices in underserved areas requires providing innovative educational offerings to address APRN business skills needs.     

局部晚期乳腺癌新辅助放疗研究进展

乳腺癌发病率居世界女性癌症发病率首位,随着医学技术的进步,乳腺癌患者总生存率得到了提高,但是局部晚期乳腺癌的治疗仍然是棘手的临床问题。对于局部晚期乳腺癌,术后辅助放疗是常规治疗手段,而新辅助放疗在局部晚期乳腺癌治疗中地位尚不明确,本文综述局部晚期乳腺癌新辅助放疗的相关研究进展,希望为局部晚期乳腺癌的治疗提供参考。     

维生素A对糖基化终末产物诱导的角膜上皮细胞损伤的作用及机制研究

目的糖基化终末产物(AGEs)在糖尿病患者在角膜外伤或接受角膜手术时极易出现角膜上皮愈合延迟甚至不愈的过程中起着关键作用,本文研究维生素A(VA)对以糖基化终末产物AGE-BSA诱导角膜上皮细胞损伤的影响及可能的作用机制。方法以HCE-2细胞为研究对象,AGE-BSA为诱导剂,试剂盒检测VA对细胞凋亡率及线粒体膜电位的影响,荧光显微镜检测细胞内凋亡小体,Western blot检测相关的蛋白表达量。结果VA抑制AGE-BSA诱导的HCE细胞凋亡,调节AGEBSA引起的凋亡相关蛋白的变化。同时,VA与JNK的抑制剂同等程度的减少AGE-BSA诱导的JNK和NF-κB的磷酸化。结论VA可能通过抑制JNK介导的NF-κB炎症通路而起到减少AGE-BSA诱导的角膜上皮细胞凋亡的作用,可以作为糖尿病患者角膜上皮损伤的保护剂。     

多细胞过继性免疫治疗治疗晚期恶性肿瘤的近期疗效及安全性分析

目的:初步观察DC、CIK、γδT、CD3AK及NK细胞多细胞过继性免疫治疗对晚期恶性肿瘤患者的近期临床疗效及安全性分析。方法:对我院在2014年10月至2015年10月收治的162例次晚期恶性肿瘤患者进行多细胞过继性细胞免疫治疗，血细胞分离机单采自体外周血单个核细胞（peripheral blood mononuclear cells，PBMC)，体外培养扩增DC、CIK、γδT、CD3AK及NK细胞，采用FCM法检测各细胞表型，并按计划序贯回输给患者进行治疗。结果:69例（43%）患者临床症状有不同程度改善，尤其是精神、食欲及睡眠质量改善最为明显，安全性分析显示主要不良反应为发热，占15%，28例完成3疗程免疫治疗患者瘤体变化为部分缓解（partial remission，PR）2例，疾病稳定（stable disease，SD）16例，疾病控制率（disease control rate，DCR）为64%。结论:DC、CIK、γδT、CD3AK及NK细胞过继性免疫治疗对晚期恶性肿瘤安全有效，可明显改善其生活质量，具有一定的临床应用前景。     

Progression-free survival and one-year milestone survival as surrogates for overall survival in previously treated advanced non-small cell lung cancer

The advent of immunotherapy leads to greater availability of effective subsequent treatments and extended survival in previously treated advanced non-small cell lung cancer (NSCLC), complicating the evaluation of overall survival (OS) in second-line NSCLC trials. Here, we aimed to assess the surrogacy of progression-free survival (PFS) and milestone survival for OS in second-line NSCLC trials investigating chemotherapy, targeted therapy and immunotherapy, respectively. We systemically searched for active-controlled, second-line NSCLC trials. The milestone time point was set at one-year based on pre-analysis. A two-stage meta-analytic validation model was adopted to assess associations between surrogate endpoint (SE) and OS and associations between treatment effects on SE and OS. Treatment effects on SE and OS were expressed as PFS hazard ratios (HR_PFS), 1 yr-milestone ratio (Ratio_1y-SUR) and HR_OS. Subgroup analyses stratified by treatment types and trial publication years evaluated the surrogacy in different clinical contexts. The study included 50 trials with 22,804 patients. One-year survival strongly correlated with OS (R²[95% confidence interval]: one-year survival -median OS = 0.707 [0.704–0.708]; Ratio_1y-SUR-HR_OS = 0.829 [0.828–0.831]). No correlation was established between PFS and OS (median PFS-median OS = 0.100 [0.098–0.101]; HR_PFS-HR_OS = 0.064 [0.059–0.069]), except in immunotherapy subgroup (HR_PFS-HR_OS = 0.835 [0.791–0.918]). In subgroup analyses, surrogacy of one-year survival persisted in different clinical contexts, and the disassociation between PFS and OS persisted in recent trials. One-year milestone survival showed strong surrogacy for OS in second-line NSCLC trials. Although no association was identified between PFS and OS, the strong HR_PFS-HR_OS correlation in immunotherapy trials indicates the potential of PFS as a SE in NSCLC trials involving immunotherapies.     

FOLFOX4化疗方案联合免疫治疗在中晚期肝癌中的应用价值(附2例报告)

目的:探讨FOLFOX4化疗方案联合全身免疫治疗在中晚期肝细胞癌中的应用价值及疗效。方法:回顾性分析2例在空军军医大学唐都医院就诊的中晚期肝癌患者资料，给予FOLFOX4全身化疗联合胸腺法新的免疫治疗后患者病情缓解，疾病完全控制。分析FOLFOX4化疗方案在中晚期肝癌中的应用价值，及联合应用时机选择。结果:2例中晚期患者中，其中1例患者合并有双肺转移瘤，全身化疗后7个周期肺转移瘤消失，肿瘤标志物降至正常。另1例患者肝癌破裂根治术后，患者腹腔转移瘤切除术后，给予全身联合治疗，患者2年内病情稳定，肿瘤标志物正常。结论:FOLFOX4化疗方案在中晚期肝癌患者中的效果是肯定的，联合胸腺法新的全身辅助免疫治疗有助于增强全身化疗的疗效，改善患者的总体生存预后。     

香砂六君子汤加味治疗放化疗后中晚期肺癌的临床研究

目的:分析中晚期肺癌患者放化疗后使用加味香砂六君子汤疗效。方法:选择2017年8月-2018年8月在我院进行肺癌中晚期放化疗的70例病患为研究样本,采取随机排列表法将其分成常规组与实验组,每组35例。给予常规组康艾注射液静脉滴注联合吗丁啉口服治疗,给予实验组加味香砂六君子中药汤剂治疗。对比两组治疗效果以及证候积分情况。结果:常规组与实验组用药后证候积分平均值分别是(12.46±5.41)分、(5.66±5.01)分(P<0.05);实验组与常规组用药后总有效率分别是97.14%(34/35)、77.14%(27/35),P<0.05;实验组用药后在食欲不振、排便异常、疲倦无力方面证候积分均低于常规组(P<0.05)。结论:中晚期肺癌病患放化疗后容易导致出现食欲不振等情况,使用加味香砂六君子中药汤剂可有效改善其临床表现,具有临床推广价值。