Polyanhydride Microcapsules Exhibiting a Sharp pH Transition at Physiological Conditions for Instantaneous Triggered Release.

Stimulus-responsive microcapsules pose an opportunity to achieve controlled release of the entire load instantaneously upon exposure to an external stimulus. Core-shell microcapsules based on the polyanhydride poly(bis(2-carboxyphenyl)adipate) as a shell were formulated in this work to encapsulate the model active substance pyrene and enable a pH-controlled triggered release. A remarkably narrow triggering pH interval was found where a change in pH from 6.4 to 6.9 allowed for release of the entire core content within seconds. The degradation kinetics of the shell were measured by both spectrophotometric detection of degradation products and mass changes by quartz crystal microbalance with dissipation monitoring and were found to correlate excellently with diffusion coefficients fitted to release measurements at varying pH values. The microcapsules presented in this work allow for an almost instantaneous triggered release even under mild conditions, thanks to the designed core-shell morphology.

The Evolving Role of Haematology Nursing Practice: A Cross-Sectional Survey.

Background And Objectives: The scope of haematology nursing practice is dynamic and must respond to advances in treatment, patients' needs and service requirements. Little is known, however, about the different roles of haematology nurses across the European setting. The purpose of this study was to identify the professional practices of haematology nurses. Method: A cross-sectional online survey design was used to investigate practice elements undertaken by haematology nurses. Frequencies and descriptive statistics were calculated for demographic variables and chi-square tests to examine relationships between practice elements, nursing role and country. Results: Data is reported from 233 nurses across 19 countries, working as Staff Nurses (52.4%), senior nurses (12.9%) and Advanced Practice Nurses (APNs) (34.8%). Most frequently reported activities included medication administration - oral/ intravenous (90.0%), monoclonal antibodies (83.8%), chemotherapy (80.6%), and blood components (81.4%). APNs were more commonly involved in nurse-led clinics and prescribing activities (p < .001, p = .001, respectively); however, other nursing groups also reported performing extended practice activities. Patient and carer education was a significant part of all nurses' roles; however, senior nurses and APNs were more often involved with the multidisciplinary team (p < .001) and managerial responsibilities (p < .001). Nurses' involvement in research was limited (36.3%) and frequently reported as an out-of-work hours activity. Conclusions: This study describes haematology nursing care activities performed in various contexts and within different nursing roles. It provides further evidence of nursing activity and may contribute to a core skills framework for haematology nurses.

Patient Confidence and Information Preferences During the Treatment Decision-making Process: Results From a Large Multiple Myeloma Patient Survey Across 12 Countries in Europe and Israel.

BACKGROUND: The relapsing nature of multiple myeloma (MM) means that patients typically receive different and multiple lines of therapy, requiring many treatment decisions over the disease course. The aim of this study was to explore patient confidence and information preferences during the treatment decision-making process. PATIENTS AND METHODS: A multinational, cross-sectional survey enrolled patients with MM. It was co-developed and distributed by Myeloma Patients Europe across 12 countries in Europe and Israel from May 2019 to March 2020. Eligibility criteria included a self-reported diagnosis of MM and being able to recall the decision-making process at the start of their latest treatment line. RESULTS: A total of 1559 patients were included, with complete responses received from 1081 (69%) patients. The median age range was 54 to 64 years; there was an equal gender split and 57% had their latest treatment decision made within the past year. Overall, 54% of patients felt "very confident" in the latest treatment decision. Patients deemed the most important information to be safety/tolerability and treatment effectiveness, but the latter was among the least frequently received. Most patients reported that their primary physician treating MM was their main source for all types of information (range, 62%-94%), with 87% of patients reporting a "very good" or "good" relationship with them. CONCLUSION: Over half of patients felt very confident in their latest treatment decision; however, patients reported not routinely receiving important treatment effectiveness information. Addressing the discrepancies between information that patients receive and consider important may enhance confidence in decision-making.

The EBMT Immune Effector Cell Nursing Guidelines on CAR-T Therapy: A Framework for Patient Care and Managing Common Toxicities.

Chimeric antigen receptor T-cell (CAR T) therapy is a new and rapidly developing field. Centers across the world are gaining more experience using these innovative anti-cancer treatments, transitioning from the 'bench' to the 'bedside', giving benefit to an increasing number of patients. For those with some refractory hematological malignancies, CAR-T may offer a treatment option that was not available a few years ago.CAR-T therapy is an immune effector cell and precision/personalized medicine treatment which is tailored to the individual patient and associated with a variety of unique adverse events and toxicities that necessitate specialist nursing/medical vigilance in an appropriate clinical setting. Subtle unrecognized signs and symptoms can result in rapid deterioration and, possibly, life threatening cardiorespiratory and/or neurological sequelae.These guidelines have been prepared for nurses working in cellular therapy in inpatient, outpatient and ambulatory settings. Many nurses will encounter cellular therapy recipients indirectly, during the referral process, following discharge, and when patients are repatriated back to local centers. The aim of these guidelines is to provide all nurses with a practice framework to enable recognition, monitoring and grading of CAR-T therapy-associated toxicities, and to support and nurse these highly complex patients with confidence.They have been developed under the auspices of several bodies of the European society for Blood and Marrow Transplantation (EBMT), by experienced health professionals, and will be a valuable resource to all practitioners working in cellular therapy.

Resource utilization for chimeric antigen receptor T cell therapy versus autologous hematopoietic cell transplantation in patients with B cell lymphoma.

CD19-directed chimeric antigen receptor T cells (CAR-T) have emerged as a highly efficacious treatment for patients with relapsed/refractory (r/r) B cell lymphoma (BCL). The value of CAR-T for these patients is indisputable, but one-off production costs are high, and little is known about the ancillary resource consumption associated with CAR-T treatment. Here, we compared the resource use and costs of CAR-T treatment with high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) for patients with r/r BCL. Standard operating procedures were used to develop a process model in ClipMedPPM, which comprises all activities and processes to sustain or generate treatment components that together constitute a treatment path. The software allows a graphic representation and the use of standardized linguistic elements for comparison of different treatment paths. Detailed processes involved in CAR-T treatments (n = 1041 processes) and in ASCT (n = 1535) were analyzed for time consumption of treatment phases and personnel. Process costs were calculated using financial controlling data. CAR-T treatment required ~ 30% less staff time than ASCT (primarily nursing staff) due to fewer chemotherapy cycles, less outpatient visits, and shorter hospital stays. For CAR-T, production costs were ~ 8 × higher, but overall treatment time was shorter compared with ASCT (30 vs 48 days), and direct labor and overhead costs were 40% and 10% lower, respectively. Excluding high product costs, CAR-T uses fewer hospital resources than ASCT for r/r BCL. Fewer hospital days for CAR-T compared to ASCT treatment and the conservation of hospital resources are beneficial to patients and the healthcare system.

Investigating the self-perceived educational priorities of haematology nurses.

PURPOSE: To identify the educational priorities of haematology nurses in relation to nursing care of patients with haematological conditions. METHOD: We used an online survey questionnaire to identify educational priorities and preferences for learning in haematology nurses across a European setting. Frequencies and descriptive statistics were calculated for demographic variables and chi-square tests to examine relationships between educational needs and demographic variables. RESULTS: 265 nurses from 21 countries responded, the majority being Staff Nurses (37.7%), with >5 years experience in haematology (77.3%) and educated to degree level or above (66.0%). The top 5 educational priorities were disease specific information for lymphoma, disease specific information for leukaemia, management of long-term side effects, understanding the immune system and new treatments in haematology. Demographic variables such as length of experience and patient group cared for influenced some educational priorities. Attending educational conferences was the preferred learning method. CONCLUSIONS: This study provides insight into self-perceived educational priorities for haematology nurses and priorities to inform development of educational initiatives.

[Mouthrinse in oral mucositis in the context of allogeneic stem cell transplantation: a qualitative study]. / Mundspülung bei oraler Mukositis im Kontext der allogenen Stammzell-Transplantation.

BACKGROUND: Oral mucositis is a common side effect of allogeneic stem cell transplantation and can lead to increased morbidity, mortality and higher costs. It also has an impact on the quality of patients' lives. In the stem cell transplantation ward of a Swiss university hospital, patients are instructed according to current guidelines for mouthwash and their mouth status is evaluated daily. RESEARCH QUESTION: How do patients experience oral mucositis and what factors influence their behaviour to perform the mouth rinsing regularly? METHOD: In this qualitative part of a concurrent nested mixed methods research, 14 patients were interviewed using an interview guide. Data was analysed using content analysis methods. RESULTS: The results showed that, oral mucositis cannot be viewed separately from illness, isolation and care. The mucositis was only a heavy burden for patients with a severe occurrence. For patients with lower grade occurrences, other symptoms were more important. The research identified motivating and debilitating factors for a regular mouth rinsing, which is one of the most important preventive procedures. CONCLUSIONS: This study highlights how important it is to view oral mucositis in the context of the transplantation and that knowledge about motivating and hindering factors can support the nurses in caring for the patients. Improvement of patient self-management is a key aspect.

Defining the scope of haematology nursing practice in Europe.

PURPOSE: The changing role of haematology nurses has never been mapped systematically which makes it difficult to plan practice development initiatives in a strategic manner. METHOD: A survey was conducted to gain insight into the role of European haematology nurses and identify their learning needs. RESULTS: Two hundred and seventy one questionnaires were completed by nurses from 25 countries, most of who were unit-based clinical nurses (116, 43%), had 10 years or more of experience in haematology (56%) and no specialist qualification (65%). The most common professional activities undertaken involved the detection and management of side effect. Respondents believe that they are well trained, possess good communication skills and play a key role within the multidisciplinary team. However, a small but significant number of nurses indicated that they had a limited role to play in patient education (42%) and only 38% (102) agreed that they played an important role in facilitating patient choice. Lack of time, limited course availability and staff shortages are perceived as key barriers to developing practice. CONCLUSIONS: Nurses are most interested in receiving further education about graft versus host disease and late effects of treatment. The knowledge component of the questionnaire revealed numerous deficits. Demographic factors such as role and experience had a significant influence on responses.