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Aim: This study investigated the levels of depression and anxiety in nurses and nursing assistants working in long‐term care facilities during the COVID‐19 pandemic. We also explored the potential causes of depression and anxiety in nurses and nursing assistants working in long‐term care facilities during the pandemic. Background: The COVID‐19 pandemic has had a considerable impact on long‐term care facilities. The high infection and mortality rates for COVID‐19 have resulted in an increased workload for caregivers. Introduction: The COVID‐19 pandemic exposed caregivers working in long‐term care facilities to higher risks of anxiety and depression. Additionally, the high risk of infection in the work environment and concerns about spreading COVID‐19 to family members and long‐term care facility residents led to various forms of stress among caregivers. Methods: The present study was a cross‐sectional study. Questionnaires were used to investigate depression and anxiety among regarding nurses and nursing assistants working in long‐term care facilities during the pandemic. Results: The depression and anxiety levels of the nurses were higher than nursing assistants, but had no statistically significant difference (p = 0.551). The factors influencing levels of depression and anxiety in nurses contained facility affiliation and experience working. In terms of nursing assistants, age, marital status, and facility affiliation were correlated with the levels of depression and anxiety. Discussion: The pandemic has severely impacted caregivers. In the process of implementing pandemic prevention measures and providing care for COVID‐19 patients, safeguarding the psychological health of caregivers is also essential. Conclusion: The levels of depression and anxiety in nurses were higher than in nursing assistants working in long‐term care facilities during the pandemic. Implication for nursing and health policy: Long‐term care facilities managers are recommended to enhance the education and training process for caregivers. Managers are also recommended to ensure provision of sufficient amounts of pandemic prevention equipment and resources. [ABSTRACT FROM AUTHOR]

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21–1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02–1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03–1.33) and renal failure (OR = 1.63, 95% CI = 1.42–1.86), high fall risk (OR = 2.67, 95% CI = 2.30–3.10), and being bedridden (OR = 6.55, 95% CI = 5.48–7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15–2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally. [ABSTRACT FROM AUTHOR]

With the proliferation of paid mobile learning applications (m-learning apps), understanding how to assess their success has become an important issue for academics and practitioners. Based on the information systems (IS) success models and the value-based adoption model, this study developed and validated a multidimensional model for assessing paid m-learning app success. The proposed model describes the interrelationships among seven paid m-learning app success variables: system quality, information quality, perceived enjoyment, perceived fee, user satisfaction, intention to reuse, and learning effectiveness. Data collected from 160 paid m-learning app users were tested against the research model using structural equation modeling (SEM). The empirical findings provide evidence that learning effectiveness is affected by user satisfaction and intention to reuse, which, in turn, are determined by system quality, information quality, perceived enjoyment, and perceived fee. The findings of this study provide several important theoretical and practical implications for the development, implementation, and promotion of paid m-learning apps.

Aims: Sodium‐glucose cotransporter 2 inhibitors (SGLT‐2is) have been demonstrated to be associated with cancer cell mechanisms. However, whether they increase the risk of cancer remains unclear. Thus, this study aimed to determine the association between SGLT‐2i use and the incidence of cancer in patients with diabetes mellitus (DM) in Taiwan. Materials and Methods: This retrospective cohort study was based on the Taiwan National Health Insurance database. The study population comprised patients with DM, and those who first used SGLT‐2is during 2016–2018 were assigned to the study group. Greedy propensity score matching was performed to select patients who first used dipeptidyl peptidase 4 inhibitors (DPP‐4is), and these patients were assigned to the control group. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for cancer risk in the study and control groups; this model was adjusted for demographic characteristics, DM severity, comorbidities and concomitant medication use. Results: After controlling for relevant variables, the SGLT‐2i cohort (aHR = 0.90, 95% CI = 0.87–0.93) had a significantly lower risk of developing cancer than the DPP‐4i cohort, particularly when the SGLT‐2i was dapagliflozin (aHR = 0.91, 95% CI = 0.87–0.95) or empagliflozin (aHR = 0.90, 95% CI = 0.86–0.94). Regarding cancer type, the SGLT‐2i cohort's risk of cancer was significantly lower than that of the DPP‐4i cohort for leukaemia, oesophageal, colorectal, liver, pancreatic, lung, skin and bladder cancer. Conclusions: SGLT‐2i use was associated with a significantly lower risk of cancer than DPP‐4i use. [ABSTRACT FROM AUTHOR]

Objectives: Patients with terminal cancer often experience physical and mental distress. Signing a do-not-resuscitate order (DNR) is crucial to protect against invalid treatment. This study aims to explore the effect of hospice shared care intervention by medical staff on the completion of a DNR-S (DNR order signed by surrogates) for patients with terminal cancer. Method: The cross-sectional study in this research involved secondary analysis of data from the 2011–2015 clinical cancer case management database of a medical center in central Taiwan. Those with a DNR order signed by patients (DNR-P) or DNR-S before the hospice shared care consultation were excluded from this study; a total of 1,306 patients with terminal cancer were selected. Results: This study demonstrated that the percentage of DNR-S after consultation involving both nurse and physician was 75.4%. With other variables controlled, the number of DNR-Ss after consultation with a nurse was significantly lower [odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.42–0.75] and that of DNR-Ss after consultation involving both nurse and physician was significantly higher (OR = 1.35, 95% CI = 1.01–1.79), than that of DNR-Ss after consultation with only the physician. Significance of results: Joint involvement of the nurse and physician in hospice care provides sufficient information to patients and family with terminal cancer about their condition and enhances doctor–patient communication. This effectively assists patients with terminal cancer and their family members in making the major decision of signing a DNR, alleviates the concerns of patients and family members about signing a DNR, and reduces terminal cancer patients' pain at the end of life to ensure that they die in peace and dignity. [ABSTRACT FROM AUTHOR]

Ischemic stroke is the most prevalent stroke condition in the world resulted in either a transient ischemic attack or long‐lasting neurological problems due to the interrupted or reduced blood flow to the brain. Antrodia camphorata is a well‐known medicinal mushroom native to Taiwan and is familiar due to its medicinal effects. The current study investigated the protective effect of A. camphorata‐alcohol extracts (AC‐AE) against cobalt (II) chloride (CoCl2)‐induced oxidative stress in vitro and ischemia/reperfusion‐induced brain injury in vivo. The rats were pre‐treated with AC‐AE for 4 weeks. Our results showed that AC‐AE reduced cell damage and decreased reactive oxygen species (ROS) production in C6 and PC12 cells under CoCl2‐induced hypoxic condition. AC‐AE doses (385, 770, 1,540 mg/kg/day, 4 weeks) increased nuclear factor erythroid 2–related factor 2 (Nrf2) and heme oxygenase‐1 (HO‐1) mRNA expressions and decreased inducible nitric oxide synthase (iNOS) and cyclooxygenase‐2 (COX‐2) mRNA expressions in Sprague Dawley rat. Besides, it decreased stroke infarct size and increased the level of antioxidants in both brain and serum. Furthermore, it reduced the formation of malondialdehyde (MDA) after ischemia/reperfusion (I/R). Our results suggested that AC‐AE exerted an effective reduction of ischemia stroke by regulating ROS production. [ABSTRACT FROM AUTHOR]