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Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, the mechanical damage from the trauma causes immediate acute cell dysfunction and cell death. Then, secondary mechanisms of injury further propagate the cell dysfunction and cell death over the course of days, weeks, or even months. Among the secondary injury mechanisms, inflammation has been shown to be a key determinant of the secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in addition to surgical management of SCI, selectively targeting the immune response following SCI could substantially decrease the progression of secondary injury and improve patient outcomes. In order to develop such therapies, a detailed molecular understanding of the timing of the immune response following SCI is necessary. Recently, several studies have mapped the cytokine/chemokine and cell proliferation patterns following SCI. In this review, we examine the immune response underlying the pathophysiology of SCI and assess both current and future therapies including pharmaceutical therapies, stem cell therapy, and the exciting potential of extracellular vesicle therapy.

Background: Despite global population aging, fragmented care remains a significant obstacle to the provision of effective health care, particularly to older adults with complex health needs. Purpose: This study was designed to synthesize current qualitative research on nurses’ experiences with care fragmentation in caring for aging populations. Methods: A comprehensive search of two electronic databases was conducted to identify relevant literature published in English. A total of 20 articles covering a total of 296 nurse participants were included in this synthesis. The extracted data were thematically synthesized. Results: Four main themes and 10 subthemes were identified in the synthesis. The themes included (1) challenges in accessing and delivering health care services, (2) challenges in communications and coordination, (3) the need to advance nurses’ roles and recognize their contributions, and (4) the importance of providing patient-centred care. Conclusions/Implications for Practice: The findings of this study highlight the complexities and challenges of providing care to aging populations within fragmented health care systems. The difficulties faced by nurses in accessing resources, coupled with communication and coordination barriers, underscore the need for systemic improvements to facilitate effective care delivery. The theme related to nurse recognition highlights the need for greater support and acknowledgement of the contributions of nurses, which is essential to ensuring care quality and patient outcomes. Moreover, the emphasis on patient-centered care reinforces the importance of adopting individualized care strategies that cater to the unique needs of older adults. Health care systems should prioritize initiatives aimed at improving communication and coordination among health care providers, supporting nursing staff, and implementing patient-centered care practices. These efforts are crucial to overcoming the challenges of fragmented care and ensuring older populations receive the comprehensive and effective care they deserve.

Background: Patients undergoing open heart surgery may experience negative emotions such as anxiety, fear, panic, and anger in the preoperative period that may negatively affect their postoperative recovery. Purpose: This study was designed to compare the effects of preoperative fear and anxiety on postoperative pain and complications in a referral group and on a non-referral group. Methods: This descriptive study was conducted at a cardiovascular surgery hospital in Turkey from July 1, 2020, to December 31, 2020, on 96 patient participants. The referral group (n = 48) comprised patients who were diagnosed in another hospital and received cardiovascular surgery at our hospital, while the non-referral group (n = 48) comprised patients who received their angiography and cardiovascular surgery in our hospital. A Personal Information Form, Surgical Fear Questionnaire, and the Beck Anxiety Inventory were administered to all of the participants in the preoperative period. In the postoperative period, pain levels were determined using the Visual Analog Scale, and complications were recorded. Results: No statistically significant difference were found in the overall occurrence of complications between the two groups (p ＞ .05). However, those in the referral group who developed lung-related complications exhibited significantly higher levels of surgical fear (p ＜ .05). No statistically significant differences were observed between the groups in terms of length of stay in the intensive care unit, length of intubation, length of mobilization, length of hospitalization, pain levels, or mean anxiety and surgical fear scores (p ＞ .05). A significantly positive relationship was observed between anxiety and surgical fear levels in both groups (p ＜ .05). Conclusions/Implications for Practice: The results indicate neither the timing of surgical treatment decision nor preoperative fear and anxiety are associated with postoperative pain and certain complications. However, a significant relationship was detected between preoperative anxiety and surgical fear. No relationship between the way patients are taken to surgery and levels of anxiety and surgical fear or postoperative complications was found. The literature should be further expanded by conducting different studies on this subject.

Background: The lack of a comprehensive assessment tool to evaluate patient understanding of the benefits and risks of complementary therapies (CTs) in diabetes management may lead to the unsafe use of CTs alongside conventional treatments, increased risk of misinformed decision-making, potential adverse interactions, and compromised health outcomes. Purpose: In this study, an instrument was developed to assess patient understanding of the benefits and risks of using CTs in diabetes management and its psychometric properties were evaluated. Methods: A two-phase design, including scale development and psychometric validation, was used. In Phase 1, the initial scale items were revised and confirmed by a panel of experts for content validity. In Phase 2, a cross-sectional survey was conducted to assess the scale’s psychometric properties, including reliability and validity analyses. A sample of 307 outpatients with diabetes who had used CTs all completed a sociodemographic, clinical characteristics, and CT usage data sheet, as well as the Understanding the Benefits-Risks of CT Use in Diabetes Scale and the Diabetes Empowerment Scale. The developed scale was validated using exploratory and confirmatory factor analyses that used structural equation modeling to confirm construct validity, Person correlation to confirm criterion-related validity, and Cronbach’s α coefficient to confirm reliability. Results: The initial 16-item Understanding the Benefits-Risks of CT Use in Diabetes Scale was assessed as having a content validity index of .88. Factor analyses reduced the scale to 15 items in four dimensions, including the patient’s medical condition for CT use (four items), the benefit-risk assessment of CTs use (four items), the suitability of CT use (five items), and the support from health care professionals (two items). The model met all goodness-of-fit indices (GFI=.90, AGFI= .90, CFI= .94, NFI=.926, RMSEA=.08, and χ2/df =3.14). The reliability analysis indicated good internal consistency (α=.912) and correlation with the Diabetes Empowerment Scale (r=.425). Conclusions/Implications for Practice: The Understanding the Benefits-Risks of CT Use in Diabetes Scale offers valuable insights for both patients and health care professionals. By providing a comprehensive assessment of patient knowledge and awareness of their CT use, this tool helps health care professionals identify gaps in patient understanding, tailor patient education, and ensure safe and effective integration of CTs into diabetes management programs.

Background: The definition of frailty is still debated, resulting in the development of various measurement tools. Having a convenient and accurate frailty screening instrument is essential to providing appropriate care to community-dwelling older adults in terms of facilitating the delayed onset of frailty and preventing disability. Purpose: This study was conducted to develop a simple, convenient, and rapid screening method for frailty classification in community-dwelling older adults that incorporates the most significant predictive factors from the Study of Osteoporotic Fractures index components and the Kihon Checklist tool domains. Methods: Convenience sampling was used to gather longitudinal data from 110 community-dwelling older adults at baseline (T0), 6 months (T1), and 1 year (T2) using three different frailty screening tools. The Fried frailty phenotype tool was used as the gold standard. Linear discriminant analysis was conducted to create an effective model for accurately classifying frailty states. Results: The discriminant analysis generated three statistical significant functions, which respectively explained 33.6% (Rc= .58; df =3; p＜.0001), 26.0% (Rc= .51; df =2; p＜ .0001), and 29.2% (Rc= .54; df= 2; p＜.0001) of the predictive power of prefrail/frail risk. The discriminant functions demonstrated sensitivities of 64.6%–69.4% for identifying the prefrail/frail group and specificities of 77.1%–90.9% for identifying the robust group. The developed method successfully classified the correct robust and prefrail/frail states for 71.6%–79.1% of participants. The findings of this longitudinal study show weight loss, reduced energy levels, physical function, activities of daily living (IADL lifestyle), and eating function to be the most significant factors at baseline for accurately classifying community-dwelling older adults into robust and prefrail/frail states over a 1-year follow-up period. Conclusions/Implications for Practice: Eating function was identified as the strongest factor of influence on the correct prediction of frailty status. Nurses may use the five questionnaire- based domains in initial assessments to classify frailty in community-dwelling older adults with a 1-year accuracy of at least 70%. Those identified as at-risk should be referred to physicians, nutritionists, rehabilitation specialists, and/or long-term care services to optimally delay or prevent the onset of frailty in this population.

Background: Since the outbreak of the COVID-19 pandemic in 2019, frontline health care workers have experienced significant stress due to concerns about their own infection risk, fear of transmitting the virus to their families, societal stigmatization, changes in work hours, and uncertainties regarding disease progression. However, the related studies in the literature focus predominantly on psychological distress among nurses, physicians, and administrative staff during the pandemic and its factors of influence, with few studies exploring this issue in nurses during the postpandemic period. This study was developed to address this gap. Purpose: This study was designed to investigate psychological distress among nurse practitioners during the post–COVID-19 pandemic era and its associated factors. Methods: This cross-sectional study was conducted in a hospital in southern Taiwan from May 1 to July 31, 2023. The cohort included 98 nurse practitioners. Study data were collected using a personal demographics datasheet, the Depression, Anxiety, And Stress Scale-21 (DASS-21), and the stress scale of caring for highly-infectious–disease patients. Data were analyzed using descriptive statistics, the independent samples t test, one-way analysis of variance, Pearson’s correlation, and multiple linear regression. Results: The mean DASS-21 score was 14.17 (SD = 9.56), with mean scores for depression, anxiety, and stress of 8.18 (SD = 6.9), 6.92 (SD = 6.32), and 13.24 (SD = 8.14), respectively; all indicative of normal levels of depression, anxiety, and stress. The mean stress scale of caring for highly-infectious–disease patients was 48.89 (SD = 18.50). The results of a multiple linear regression analysis revealed participants aged 35–44 and older than 45 years experienced higher levels of stress while caring for highly-infectious–disease patients than their counterparts aged 25–34 years (β = 0.64, p = .006; β = 0.56, p = .027). Also, participants with 11–20 years of work experience reported lower stress in caring for highly-infectious–disease patients than their counterparts with ＜10 years of work experience (β = −0.46, p = .049). Conclusion/Implications for Practice: In this study, nurse practitioners aged 35 years and above and those with ＜10 years of work experience experienced greater stress following the COVID-19 pandemic. As the first study to explore psychological distress among nurse practitioners in the aftermath of the COVID-19 pandemic and its associated factors, these findings highlight the need for hospital administrators to implement support measures to support nurse practitioners tailored to age group and family status to mitigate long-term psychological distress and its impact on fatigue and care quality.

Background: Nurse practitioners (NPs) play a pivotal role in controlling rising health care expenses and addressing patient preferences and emerging health disparities. However, their work may lead to work-related stress, low well-being, low resilience, and a decreased sense of personal accomplishment. Purpose: The aim of this study was to examine the relationships between well-being and resilience, respectively, with sense of personal accomplishment in the context of NPs. Methods: A cross-sectional correlational study was conducted on NPs in a medical center in southern Taiwan. The three instruments used to collect study data included the Well-being Index for well-being, the Connor–Davidson Resilience Scale (CD-RISC-25) for resilience, and the Maslach Burnout Inventory–Human Services Survey–Chinese version for personal accomplishment. Results: Good well-being, moderate resilience, and a high level of personal accomplishment were found in the 126 NP participants. Those who were married had a higher mean level of personal accomplishment, explaining 6.2% of the total variance. Well-being and two dimensions of resilience (1) personal competence and high standards and (2) positive acceptance of change and secure relationships were also identified as significant predictors of personal accomplishment, explaining 48.5% of the total variance. Conclusions/Implications for Practice: Sense of personal accomplishment is significantly impacted by well-being and several aspects (i.e., personal competence, high standards, and acceptance of change) of resilience. Health care managers should develop and implement strategies focused on reinforcing resilience and well-being to strengthen the sense of personal accomplishment in NPs.

Background: The number of patients with end-stage renal disease (ESRD) in Taiwan continues to rise steadily, and hemodialysis is the primary treatment for these patients. More than 50% of patients on hemodialysis are over 65 years of age, indicative of an aging patient population. Changes in lifestyle, dietary habits, and social roles after commencing hemodialysis easily cause patients to feel uncertain, depressed, and/or lonely. However, a limited number of studies have examined the issue of loneliness among older adults on hemodialysis. Purpose: This study was designed to better understand loneliness and its associated factors among older patients receiving hemodialysis. Methods: A cross-sectional research design with convenience sampling was employed with a total of 146 patients. Eligible participants aged 65 years or older and receiving hemodialysis for more than 3 months were recruited from two hospitals in northern Taiwan. Structured questionnaires, including a demographic characteristics questionnaire, the Hemodialysis Patient Fatigue Scale, Social Support Scale, and UCLA Loneliness Scale version 3, were used to collect data. Results: The mean loneliness score was 41.5 out of a maximum of 80. A significant positive relationship was found between fatigue and loneliness, and a significant negative relationship was found between social support and loneliness. Gender, fatigue, and social support were identified as predictors of loneliness. Conclusions/Implications for Practice: The results indicate that older patients receiving hemodialysis have a moderate level of loneliness. Based on the identified predictors, nurses should pay particular attention to patients who are female, are experiencing a higher fatigue level, and/or have lower social support. Future studies may use these results to develop strategies for preventing and improving loneliness among older adults receiving hemodialysis.

Background: The physical and psychological challenges faced by postpartum women adversely affect their health-related quality of life (HRQoL). However, the influence of urinary incontinence (UI), sexual dysfunction, and depressive symptoms on HRQoL across the first postpartum year remains unclear. Purposes: This study was designed to investigate the association of UI, sexual dysfunction, and depressive symptoms with HRQoL and to examine changes in HRQoL across the initial 12- month postpartum period. Methods: The participants (n =613) completed the study questionnaire at four time points: 4–6 weeks and 3, 6, and 12-months postpartum. The questionnaire was mailed from a medical center maternity unit and included the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form, Female Sexual Function Index, the Center for Epidemiologic Studies Depression Scale, and the 36-item Short-Form Health Survey. Results: Moderate to severe UI (β =−2.99), sexual satisfaction (β =−0.43), and lubrication (β =0.44; all p ＜.05) were associated with physical HRQoL over the 12-month postpartum period. Mental HRQoL was influenced by moderate to severe UI (β =−1.3), sexual satisfaction (β =0.61; both p ＜.05), and depressive symptoms (β =−11.07; p ＜.001). The lowest physical and mental HRQoL scores were identified in the first month postpartum (all p ＜.001). Physical HRQoL increased more significantly at 6 and 12 months than at 3-months postpartum (both p ≤.001). Conclusions/Implications for practice: The first month postpartum represents a critical period for assessing HRQoL, when it is lowest. UI severity, sexual satisfaction, lubrication, and depressive symptoms were all shown to impact HRQoL significantly, indicating the need for proactive evaluations and tailored interventions by healthcare providers. Future research should identify interventions that effectively improve HRQoL during the postpartum period.