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Background: Interactive e-books offer multimedia and interactive features that make them particularly suitable for learning nursing skills and also allow for easy content updating, ensuring that students learn the most current skills based on the latest clinical guidelines., Purpose: To examine the effectiveness of an interactive e-book in increasing nursing students' knowledge, confidence, and learning self-efficacy of performing nasogastric tube feeding., Methods: A randomized controlled trial was conducted with 62 nursing students, with the experimental group using an interactive e-book for learning whereas the comparison group using a printed textbook., Results: The experimental group demonstrated significantly greater knowledge and confidence improvements than the comparison group, but no significant difference was found in learning self-efficacy. The experimental group was significantly more satisfied with the learning materials than the comparison group., Conclusions: Interactive e-books are more effective in enhancing nursing students' knowledge and confidence in performing nursing skills than printed textbooks., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: There is variability in the reported prevalence of stress and anxiety among nursing students across studies, and few studies have investigated the pooled prevalence of stress and anxiety of these students., Purpose: To investigate the prevalence and associated factors related to stress and anxiety among nursing students., Methods: Various electronic databases were searched up to October 26, 2022. A random-effects model and a moderator analysis were used to examine the overall prevalence and related factors. Begg's test was adopted to examine publication bias., Results: In total, 121 studies were included in the meta-analysis. Most nursing students experienced moderate stress (42.1%) and mild to moderate anxiety (19.4%-25.1%). Third- and fourth-year nursing students had severe stress levels compared with those in the first and second years (29.0% vs 15.1%)., Conclusions: Nurse educators should design appropriate curricula to strengthen student knowledge and provide regular assessments and supportive interventions to reduce stress and anxiety., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

This study aims to explore how the families of patients with cancer respond to and act toward complementary and alternative medicine (CAM) use. A qualitative research design based on grounded theory was adopted in this study. Semistructured and face-to-face in-depth interviews were conducted. Each participant was involved in a one-to-one individual interview. Five categories emerged regarding how the families of patients with cancer responded to and acted toward CAM use: purposes of using CAM, CAM use between patients and families, role of family caregivers, actions when using CAM, and seeking religious practice. The core category following coding emphasized the paramount importance of patients' comfort. The findings revealed that the families of patients with cancer may respond and act differently regarding patients' use of CAM. During this process, patients may not inform family members that they are using CAM. Health care professionals should consider this in their interactions with family members., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Significance: The cases illustrate Acanthamoeba coinfection with Pseudomonas aeruginosa or microsporidia in the cornea., Purpose: This case series aimed to alert clinicians toward considering Acanthamoeba coinfection in the cornea when unusual presentation such as perineuritis or epitheliitis was observed in clinical images. Increased suspicion of Acanthamoeba coinfection may facilitate early diagnosis and prompt management, eventually leading to good vision outcomes., Case Series: An 11-year-old boy wearing orthokeratology lens for myopia control complained of pain in the right eye for 1 week. A paracentral corneal ulcer with perineuritis was observed. Culture from corneal tissue revealed P. aeruginosa , and an in vivo confocal microscopic examination showed highly reflective and oval-shaped structures indicating Acanthamoeba coinfection. Corneal lesions gradually improved under 0.02% polyhexamethylene biguanidine, 0.1% propamidine isethionate, and 0.3% ciprofloxacin. At 1 year, the final best-corrected visual acuity was 20/25 with residual paracentral corneal opacity. Another 20-year-old man complained of pain in the right eye for 2 weeks. Multiple raised corneal lesions associated with epitheliitis were found. Moreover, 1% acid-fast staining showed oval-shaped spores, and microsporidia infection was inferred. In addition, polymerase chain reaction results obtained after subjecting the patient to corneal debridement revealed positivity for Acanthamoeba . Polyhexamethylene biguanidine (0.02%) and 0.5% moxifloxacin were prescribed, and the lesions subsided. At a 2-year follow-up, the final best-corrected visual acuity was 20/25., Conclusions: Perineuritis in orthokeratology lens wearers and epitheliitis without any predisposing factor are unusual presentations of Acanthamoeba coinfection in the cornea. These corneal findings should arouse the suspicion of coinfection and enable the clinicians to conduct the appropriate workup and initiate adequate treatment. This case series demonstrated that early diagnosis and prompt treatment can improve visual prognosis., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Optometry.)

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Background: Hand massage therapies have been used to relieve anxiety and pain in various clinical situations. The effects of machine-based hand massage on preoperative anxiety in ambulatory surgery settings have not been evaluated., Purpose: This prospective study was designed to investigate the effect of machine-based hand massage on preoperative anxiety and vital signs in ambulatory surgery patients., Methods: One hundred ninety-nine patients aged 18 years and older who were scheduled to receive ambulatory surgery were recruited from the Taipei Municipal Wanfang Hospital in Taipei City, Taiwan. The patients were assigned randomly to the experimental group (n = 101), which received presurgical machine-based hand massage therapy, and the control group (n = 98), which received no intervention. The patients in both groups completed the Spielberger State-Trait Anxiety Inventory short form at preintervention (baseline) and postintervention., Results: Within-group comparisons of Spielberger State-Trait Anxiety Inventory short form scores showed significant decreases between preintervention and postintervention scores in the experimental group (44.3 ± 11.2 to 37.9 ± 8.7) and no significant change in the control group. Within-group comparisons of vital signs revealed a significant increase in mean respiration rate between baseline and postintervention in both groups (both ps < .05). Blood pressure was found to have decreased significantly only in the control group at postintervention (p < .05). No significant preintervention to postintervention change in pulse was observed in either group., Conclusions: The findings of this study indicate that machine-based hand massage reduces anxiety significantly in patients awaiting ambulatory surgery while not significantly affecting their vital signs., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.)

Stroke is ranked third among the top 10 causes of death in Taiwan. Besides a high mortality rate, stroke survivors are often left with physical or functional sequela. This study aimed to explore ischemic stroke patients' decision-making process using Western medicine (WM) and complementary and alternative medicine (CAM). This study is a qualitative study based on grounded theory. A total of 12 participants were recruited. Findings revealed that the participants accepted WM and CAM treatments following the onset of ischemic stroke. Three categories and several subcategories emerged from stroke patients' decision-making process. These are "uncertainty of stroke," "delicate balance between WM and CAM," and "reestablishing confidence and faith." Eventually, they exhibited the core category of "breakthrough and the pursuit of a sense of rebirth." This study also found that the participants were unwilling to inform their health care professionals on their use of CAM. Therefore, health care professionals should empathize with the views and needs of their patients and respect their decision to combine WM with CAM. The views of other medical teams concerning CAM into their analysis of patients' decision-making process are recommended. Therefore, comprehensive insight into ischemic stroke patients' decision-making process for using CAM can be further explored.

Objective: Vascular remodeling because of smooth muscle cell (SMC) proliferation is a common process occurring in several vascular diseases, such as atherosclerosis, aortic aneurysm, post-transplant vasculopathy, restenosis after angioplasty, etc. The molecular mechanism underlying SMC proliferation, however, is not completely understood. The objective of this study is to determine the role and mechanism of Janus kinase 3 (JAK3) in vascular remodeling and SMC proliferation., Approach and Results: Platelet-derived growth factor-BB, an SMC mitogen, induces JAK3 expression and phosphorylation while stimulating SMC proliferation. Janex-1, a specific inhibitor of JAK3, or knockdown of JAK3 by short hairpin RNA, inhibits the SMC proliferation. Conversely, ectopic expression of JAK3 promotes SMC proliferation. Mechanistically, JAK3 promotes the phosphorylation of signal transducer and activator of transcription 3 and c-Jun N-terminal kinase in SMC, 2 signaling pathways known to be critical for SMC proliferation and vascular remodeling. Blockade of these 2 signaling pathways by their inhibitors impeded the JAK3-mediated SMC proliferation. In vivo, knockdown of JAK3 attenuates injury-induced neointima formation with attenuated neointimal SMC proliferation. Knockdown of JAK3 also induces neointimal SMC apoptosis in rat carotid artery balloon injury model., Conclusions: Our results demonstrate that JAK3 mediates SMC proliferation and survival during injury-induced vascular remodeling, which provides a potential therapeutic target for preventing neointimal hyperplasia in proliferative vascular diseases., (© 2017 American Heart Association, Inc.)

Background: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied., Purpose: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities., Methods: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale., Results: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms., Conclusions/implications for Practice: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.

Neutrophil extracellular traps (NETs), which consist of neutrophil DNA and cytoplasmic proteins, have been shown to be involved in various infectious, inflammatory, and autoimmune diseases. Neutrophil extracellular traps are abundant at the site of infection and acute inflammation. Neutrophil extracellular trap formation can occur through various intracellular signaling pathways, including peptidylarginine deiminase 4, Raf-MEK-ERK, nitric oxide, Toll-like receptor 4, high mobility group box 1, pentraxin 3, and mammalian targets of rapamycin. A growing body of evidence indicates that NETs may play an important role in injury, and decreases in NETs could reduce tissue injury. Neutrophil extracellular traps are believed to modulate the inflammatory and immune responses of individuals after injury. In this review, the role of NETs in injury, including traumatic injury, ischemia-reperfusion-induced injury, and sepsis, as well as the potential markers and therapeutic targets of NET-related injury will be discussed.

Background: Taiwanese public health nurses are increasingly required to act as case managers. However, little is known about nurses' knowledge and preparedness levels in assuming the responsibilities of case management., Purpose: This article explores the knowledge and preparedness levels of experienced public health nurses related to case management., Methods: A cross-sectional survey of Taiwanese public health nurses was conducted. A structured questionnaire was used to collect data on participants' knowledge of case management and perceived preparedness levels in performing role activities. The questionnaire consisted of three sections: Section One featured 20 multiple-choice items, Section Two included case manager role activities, and Section Three gathered demographic information., Results: One hundred seventy-eight public health nurses were recruited from 10 health offices, with a 99% valid response rate. The overall average correct response rate for case management knowledge was 49%, which fell significantly below the minimum acceptable average score of 60%. Participants held neutral opinions regarding their preparedness levels for performing case management role activities, with a mean score of 3.2 (SD = 0.5, range = 1-5). In addition, this study unexpectedly found that the higher knowledge level group was significantly younger on average than the lower knowledge group. More than three quarters (82%) of participants had no prior education in case management., Conclusions/implications for Practice: The results reflect substantial gaps in Taiwanese public health nurses' knowledge and preparation for the practice of case management. There is an urgent need to strengthen case management continuing education for public health nurses and address knowledge deficits and the role activities identified with lower preparedness levels.

This study examined the effects of an asynchronous Web-based supplementary learning program on the performance of nursing students' basic nursing skills. A posttest quasi-experimental design was used. Students in the intervention group (n = 62) were given login information to access the online program, while the control group (n = 99) was not. Data from both groups were collected before and 4 weeks after the intervention. An objective assessment of basic nursing skills was used to evaluate the level of skill demonstrated by the participants. Results indicate that the Web-based supplementary learning program is effective at strengthening students' basic nursing skills (P = .002). The findings also reveal that students in the intervention group showed higher-than-average satisfaction with the supplementary program (mean, 3.80 [SD, 0.81]). Thus, this Web-based program offers a learning opportunity for nursing students to enhance their skills beyond their formal lectures.

Background: Physical restraints are commonly used to reduce treatment interference risk and protect patient safety. However, nurses still hold misconceptions about the use of physical restraints in acute care settings. Teaching nursing staff accurate knowledge and proper skills, cultivating positive attitudes, and rectifying irregularities in physical restraint use are all necessary to improve patient care., Purpose: The aim of this study was to examine the effectiveness of a short-term in-service education program in improving nurses' knowledge, attitudes, and self-reported practices related to physical restraint use., Methods: Convenience sampling was used in this quasi-experimental study at two different branches of one hospital in southern Taiwan. The two branches were randomly assigned as either the intervention or control group. Fifty-nine nurses at one branch were assigned to the intervention group, and 70 nurses in the other branch were assigned to the control group. The developed 90-minute in-service education program was given to nurses in the intervention group. The questionnaire included demographic data and three scales (Knowledge of Physical Restraint Use, Attitudes of Physical Restraint Use, and Practice of Physical Restraint Use). These scales were used to measure critical study variables prior to and 2 weeks after the intervention., Results: Results found a significant improvement in the intervention group in terms of knowledge (p = .000), attitudes (p = .007), and self-reported practices (p = .048) related to physical restraint use after program completion. However, there were no significant differences in participant attitudes toward the use of physical restraints between intervention and control groups after program completion. CONCLUSIONS AND IMPLICATIONS FOR PRACTICES: Physical restraint knowledge and skills improved after the 90-minute in-service education program. Findings highlight the need to provide a short-term in-service education program on physical restraint use in acute care settings.

Objective: Air quality in Allegheny County, Pennsylvania, has improved over the last decade, and we investigated whether the lower concentrations of fine particulate matter (PM10) are still associated with adverse health outcomes., Methods: Daily cardiopulmonary hospital admissions in elderly residents of Allegheny County and countywide average PM10 measures were available from 1995 through 2000. Using generalized additive models (GAM), a Poisson regression model was fit to the number of daily admissions using predictor variables: lags of PM10, daily temperature and humidity, day of the week, and time., Results: Our findings suggest that there is a positive association of PM10 with hospital admissions, and the effect is related to current-day PM10 levels., Conclusions: Even at the lower levels of ambient air pollution as measured by PM10, there is still a suggestion of an adverse health effect in the elderly.