Efficacy of turmeric in the treatment of oral mucositis in patients with head and neck cancer after radiotherapy or chemoradiotherapy: a systematic review and meta-analysis.

Background: Oral mucositis is a major complication for head and neck cancer (HNC) patients after radiotherapy or chemotherapy. A meta-analysis was performed to assess the efficacy of turmeric in the treatment of oral mucositis in HNC patients. Methods: Randomized controlled trials investigating our topic were included in the meta-analysis. The clinical outcomes considered were the severity of oral mucositis, pain level, and weight loss. Results: A total of eight articles that met our inclusion criteria were included in our meta-analysis. At the 3-week follow-up visit, the turmeric group showed significantly lower grades of oral mucositis compared to the control group (p = 0.03). When compared to the placebo group, a significant difference in the degree of oral mucositis was observed at the 4-(p = 0.03) and 6-week (p < 0.00001) follow-up visits. No significant difference in pain levels was observed between the turmeric and control groups at any of the follow-up visits. However, a significant improvement in pain levels for the turmeric group when compared with the placebo group was observed only at the 6-week follow-up visit (p = 0.006). Interestingly, a significant improvement in pain levels was observed for the turmeric group at the 2-, 4-, 5-, and 6-week follow-up visits (p < 0.05) when compared to the non-placebo group. The turmeric group showed less weight loss than the control group at the final follow-up visit (p = 0.03). conclusion: Our meta-analysis showed that using turmeric may be effective in improving both the severity of oral mucositis and pain levels in HNC patients who have received radiotherapy or radiochemotherapy. In addition, the turmeric group experienced less weight loss.

Effectiveness of computerised decision aids for patients with chronic diseases in shared decision-making: A systematic review and meta-analysis.

AIMS: To synthesise the composition and effectiveness of computer-based patient decision aid (PDAs) in interventions for patients with chronic diseases. DESIGN: A systematic review with meta-analysis. METHODS: Five databases were searched, and only randomised controlled trials (RCTs)were included. This review was conducted with the PRISMA guidelines. The JBI Appraisal Tools for randomised trials were used to assess the risk of bias. We used the random-effects model to conduct meta-analyses. Evidence from RCTs was synthesised using standardised mean differences or mean differences. The GRADE system was employed to assess the certainty of evidence and recommendations. This study was registered on PROSPERO (number: CRD42022369340). DATA SOURCES: PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched for studies published before October 2022. RESULTS: The review included 22 studies, and most computer-based PDAs reported information on the disease, treatment options, pros and cons and risk comparison and value clarification. The use of computer-based PDAs showed a significant effect on decision conflict and knowledge, but not on decision regret, satisfaction, self-efficacy, anxiety and quality of life. The overall GRADE certainty of evidence was low. CONCLUSION: Although the quality of evidence was low, however, using computer-based PDAs could reduce decision conflict and enhance knowledge when making medical decisions. More research is needed to support the contention above. RELEVANCE TO CLINICAL PRACTICE: Computer-based PDAs could assist health-care providers and patients in the shared decision-making process and improving the quality of decision-making. REPORTING METHOD: This study adhered to PRISMA guidelines. NO PATIENT OR PUBLIC CONTRIBUTION.

Acupressure Improves Cognition and Quality of Life Among Older Adults with Cognitive Disorders in Long-Term Care Settings: A Clustered Randomized Controlled Trial.

OBJECTIVE: To examine the effectiveness of acupressure on cognition and quality of life (QoL) among older adults with cognitive disorders residing in long-term care (LTC) settings. DESIGN: A clustered, randomized, assessor-blinded, controlled trial with a repeated measures design. SETTING AND PARTICIPANTS: Participants were recruited from residential care facilities in Taiwan from August 2020 to February 2021. Ninety-two older residents in 18 facilities were randomized to either the intervention arm (9 facilities, n = 46) or the control arm (9 facilities, n = 46). METHODS: Acupressure was performed at Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), Fengchi (GB20), Shuigou (GV26), Neiguan (PC6), Shenmen (HT7), and Zusanli (ST36). The duration for pressing each acupoint was 3 minutes. The acupressure force was maintained at 3 kg. Acupressure was performed once a day 5 times a week for 12 weeks. The primary outcome measure was the Cognitive Abilities Screening Instrument (CASI). Secondary outcomes included the digit span backward test, the Wisconsin Card Sorting Test (perseverative responses, perseverative errors, and categories completed), semantic fluency tests of categories of animals, fruits, and vegetables, and the Quality of Life-Alzheimer's Disease (QoL-AD). Data were collected at preintervention and postintervention. Three-level mixed effects models were performed. This study complied with the CONSORT checklist. RESULTS: After adjusting for covariates, there was a significant increase in CASI scores, the digit span backward test, perseverative responses, perseverative errors, categories completed, semantic fluency tests of categories, and QoL-AD scores in the intervention versus control arm at 3 months. CONCLUSIONS AND IMPLICATIONS: This study provides support for the use of acupressure to improve cognition and QoL during care among older residents with cognitive disorders in LTC settings. Acupressure can be integrated into aged care practice to improve cognition and QoL of older residents with cognitive disorders in LTC settings.

Quality of care in the course of subcutaneous versus intravenous trastuzumab administration in patients with breast cancer: an integrated time-motion study with mixed-methods research.

OBJECTIVES: This study aimed to compare the time required and concerns raised by various perspectives of participants regarding administering subcutaneous and intravenous trastuzumab for patients with breast cancer (BC). DESIGN: This observational time-motion study design with mixed-methods research (cross-sectional surveys and semistructured interviews) was conducted. The time spent on preparing or administering trastuzumab by different healthcare professionals (HCPs) was recorded. The data were analysed by descriptive/inferential statistical analyses, followed by thematic analyses. SETTING: Outpatient and inpatient administration units of a single medical centre in Taiwan. PARTICIPANTS: The study included patients with early-stage BC who received subcutaneous or intravenous trastuzumab (n=93), and HCPs including two attending physicians, a nurse practitioner, two pharmacists and two nurses. RESULT: Based on the perspectives of patients and HCPs, the subcutaneous form of trastuzumab was more efficient, less expensive and produced less discomfort in outpatient units than inpatient units. More participants preferred the subcutaneous form over the intravenous form in both outpatient and inpatient units. Pharmacists and nurse practitioners spent threefold more time on patients when preparing and administering the intravenous form in both outpatient and inpatient units. The concerns raised by patients and HCPs varied in certain aspects, including the injection skills, speed, mental distress (eg, needle phobia) and pain associated with the subcutaneous form. Almost all patients preferred receiving the subcutaneous form in outpatient units after the initial COVID-19 outbreak. CONCLUSION: Patients with early-stage BC preferred receiving subcutaneous trastuzumab in outpatient units rather than inpatient units or the intravenous form before and after the COVID-19 outbreak. Such findings may serve as real-world evidence to facilitate better quality of care regarding administration of subcutaneous or intravenous trastuzumab in medical settings, and its feasible resolutions to balance the quality, concerns and efficiency of anticancer administration during the COVID-19 pandemic.

Effectiveness of Multimedia-Based Learning on the Improvement of Knowledge, Attitude, and Behavioral Intention toward COVID-19 Prevention among Nurse Aides in Taiwan: A Parallel-Interventional Study.

Because nurse aides are one of the first-line care providers in hospitals, they should possess better knowledge, attitude, and behavioral intention toward COVID-19 during the pandemic. This study aimed to compare the improvements of COVID-19-related education on learning outcomes between multimedia-based and traditional face-to-face learning models for nurse aides. The parallel-group randomized controlled trial recruited 74 participants in both the experimental and control groups. Two 90 min interventions with the same contents, but in different ways, were delivered. A structured questionnaire was used to collect data of demographic information, knowledge, attitude, and behavioral intention toward COVID-19 before and after the interventions. Results from generalized estimation equations analysis indicated that the nurse aides in the multimedia-based learning group had greater improvement in the scores of knowledge (difference in change: 3.2, standard error: 0.97, p < 0.001), attitude (difference in change: 10.2, standard error: 2.97, p < 0.001), and behavioral intention (difference in change: 0.5, standard error: 0.04, p < 0.001) than those in the face-to-face learning group. During the outbreak of COVID-19, multimedia-based learning as an effective learning method could improve the learning outcomes related to COVID-19 and achieve learning goals without close contact.

Effectiveness of Fucoidan on Supplemental Therapy in Cancer Patients: A Systematic Review.

PURPOSE: Fucoidan is a dietary supplement which is commonly used by cancer patients. However, despite evidence of positive effects in cell culture environments, there are currently no clinical guidelines for supplementary use of fucoidan in cancer patients. This study aims to evaluate the effectiveness of fucoidan supplemental use. METHODS: A systematic literature search was conducted using databases including Cochrane Library, JBI, PubMed, Embase, and CINAHL. All original studies on fucoidan for supplemental use in cancer patients were included. The search was made in databases without time restriction. The outcomes included disease progression status, inflammatory markers, nutritional status, adverse effects, and quality of life. The appraisal tool used was JBI-MAStARI. RESULTS: Four studies were included: One randomized controlled trial and three quasi-experimental studies. Meta-analysis was not applied due to the heterogeneity of measurement tools. Overall sample size was 118. Most participants were metastatic colorectal and gastric cancer patients. Two studies revealed a significantly longer survival time and chemotherapy treatment periods with fucoidan use. Positive but insignificant effects of disease control rate, inflammatory markers, nutrition status, fatigue, and financial difficulty were shown in those using fucoidan. CONCLUSIONS: The results of this systematic review indicate that the effects of fucoidan were inconsistent with clinical outcomes in metastatic or recurrent cancer patients. Only four studies were included, and heterogeneity in methodologies and relatively small sample sizes limited the research consensus. Although cause and effect between fucoidan and the survival time, disease control or adverse effects could not be confirmed, this study includes the most research on fucoidan in humans.

The Chinese Inventory of Psychosocial Balance Short-Form Questionnaire for the Older Adults: Validity and Reliability Study.

BACKGROUND: Drawing from Erikson's theory, Domino and Affonso constructed the Inventory of Psychosocial Balance (IPB), a scale with satisfactory reliability and validity. However, the lack of a credible Chinese version of the scale may hinder research on ego development in Taiwan. The aim of the present study was to construct a short form Chinese IPB. In addition, factor analysis was employed to shorten the original 120-item scale to make it suitable for application in the older adults in the future. METHODS: The study involved three steps: The first step was to establish the 120-items of the Chinese Inventory of Psychosocial Balance (C-IPB), and we conducted translation, back-translation, expert validity, and reliability of pilot study for this step. Following the first step was to construct the short-form C-IPB (CIPB-SF) in the second step, and the CIPB-SF was developed via item analysis and factor analysis. Finally, we assessed the reliability and validity of the CIPB-SF via structural equation model in the third step. RESULTS: Three hundred eight older adults without cognitive disorder completed the IPB. The 40-item CIPB-SF was completed through item analysis and factor analysis. The internal consistency test of CIPB-SF and the eight stages were good (Cronbach's α = 0.81-0.89). The CIPB-SF had acceptable validity, except in the intimacy and identity stages, in which validity was only fair. Compared with the IPB, the CIPB-SF had good reliability and acceptable validity. However, because of its conciseness, the 40-item CIPB-SF was more suited for application among the Chinese elderly population because its application avoids physical overload. CONCLUSION: The CIPB-SF served as a concise scale for assessing ego development in our study. This scale can also serve as a useful tool for convenient screening in the future.

The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university.

PURPOSE: To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). DESIGN AND METHODS: A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews. FINDINGS: A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up. PRACTICE IMPLICATIONS: This screen model can be used in early detection for undergraduates with HRDP from large general samples.

Evaluation of psychological training for nurses and midwives to optimise care for women with perinatal depression: a systematic review and meta-analysis.

Objective Perinatal depression is linked to poor maternal health and infant development outcomes. The World Health Organization recommends expanding the mental health education and training of primary care providers to improve the quality of perinatal depression care. The present study evaluated the effect of various psychological training methods on nurses' and midwives' competence in administering care to and alleviating symptoms in patients with perinatal depression. Methods A comprehensive search of the PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases was performed. The data were independently extracted by two reviewers, and the critical appraisal tools of the Joanna Briggs Institute were used for quality assessment. Random-effects meta-analysis was conducted using Review Manager 5.4 software. Findings A total of 13 articles including 246 nurses and midwives and 4,381 perinatal women were reviewed. Care administered through both face-to-face (relative risk [RR] 0.70, 95% confidence interval [CI] 0.61-0.74) and digital training (RR 0.44, 95% CI 0.26-0.74) significantly mitigated symptoms of perinatal depression. Significant benefits were observed after 3- to 5-day and 8-day training, for which the RR were 0.75 (95% CI 0.59-0.97) and 0.72 (95% CI 0.66-0.85), respectively. Studies with high intervention fidelity more effectively reduced the risk of depressive symptoms in perinatal women than those with low intervention fidelity. Key conclusions and implications for practice Compared with face-to-face, digital training methods were more effective in reducing the risk of depressive symptoms. High intervention fidelity and 3- to 5-day and 8-day training resulted in better outcomes. The present findings can serve as a reference for the design of psychological training programs for nurses and midwives to equip them with effective strategies for administering care to patients with perinatal depression.

The Relationship between the Second-Generation Antipsychotics Efficacy and the Traditional Chinese Medicine Body Constitutions in Patients with Schizophrenia.

BACKGROUND: Schizophrenia requires lifelong treatment; Second-generation Antipsychotics (SGAs) have become the most prescribed medication for schizophrenia patients. The efficacy of various SGAs treatment may differ in schizophrenia patients with various traditional Chinese medicine (TCM) body constitution (BC) types. METHOD: This study applied a longitudinal quantitative research design, where a total of 66 participants were recruited. The Positive and Negative Symptom Scale (PANSS) and the Clinical Global Impression (CGI) score were used to evaluate patients' psychopathology status in hospitalization, and body constitution questionnaires were conducted by face-to-face interviews in the 1st, 3rd, and 6th week of hospitalization. RESULTS: More than 60% of schizophrenia patients who were treated with SGAs were classified to have unbalanced BC types including Yin-Xu, Yang-Xu and Stasis. Generalized estimating equation analysis revealed significant time effects in CGI and PANSS score improvements in both unbalanced and gentleness (balance) BC types, but no significant changes in the group and group-time interaction in the CGI and PANSS scores in different BC type groups. CONCLUSIONS: Schizophrenia patients under SGAs treatment had a higher proportion of unbalanced BC types which may lead to poorer physical or mental statuses, such as overweight problems. Health care providers could apply interventions according to patients' BC types for disease prevention.

Online Team-Based Learning Teaching Strategy for Developing Caring Competencies in Nursing Students under COVID-19 Pandemic Restrictions.

(1) Background: The COVID-19 pandemic impacted education systems globally, and numerous strategies were used to transform education into online learning. Caring is recognized as a core competency in nursing; this competency is difficult to cultivate and measure. This study aimed to explore the effect of online team-based learning (TBL) on cultivating nursing students' caring competency. (2) Method: A mix-methods study design with convenience sampling was used for this study. The intervention was online TBL with field observation. Quantitative data were collected by the modified Peer Caring Measurement (PCM) and analyzed using descriptive and inferential statistics. Qualitative data were collected by dialog in social media and analyzed by content analysis. (3) Result: Both the quantitative and qualitative data showed a significant increase in caring competency. A paired t-test of modified PCM showed significant improvement (p < 0.001), and female students had greater learning performances compared with male students in academic and affective dimensions. Three themes emerged, including that online TBL possesses remarkable benefits, students felt in charge of their learning, and changes in the students' caring competency were revealed. (4) Conclusion: This online TBL strategy works well in teaching and fostering caring in an online environment among nursing students, which is necessary under COVID-19 restrictions.

Predicting Ego Integrity Using Prior Ego Development Stages for Older Adults in the Community.

BACKGROUND: Erikson's ego development theory is the most accepted theory that involves eight stages of psychosocial development over an individual`s all lifespan. The result of development in prior stages will influence the later stages. The elderly were mainly characterized by the central developmental tasks: achieving ego integrity vs. despair. The harvest in the last stage will be related to the attitude of facing death in the elderly. METHODS: A cross-sectional study of elderly age from 65 to 90 years old (n = 292) was carried out and investigated via the Inventory of Psychosocial Balance. Pearson correlation and path analysis were performed in order to analyze the direct and indirect effect among the first seven stages with the eighth stage. RESULTS: We found that all the eight stages were significantly related to each other, and comparing to the previous seven stages, "the generativity stage" (r = 0.77) was the most relevant stage with "ego integrity". In all indirect and direct effects, the seventh stage had the greatest impact on the "ego integrity stage"; the direct effect was 0.89. CONCLUSIONS: Compared to the whole lifespan, adulthood possessed a higher influence on the elderly stage. We found that all the eight stages were significantly related to each other, and comparing the first seven stages, the "generativity stage" (r = 0.77) was the most relevant stage to "ego integrity". CONCLUSIONS: Compared to the whole lifespan, adulthood possessed a higher influence on the elderly stage.

Electronic Device Use before Bedtime and Sleep Quality among University Students.

Using electronic devices before bedtime impacts sleep quality and has become a major public health issue. This study aims to investigate the associations between electronic devices (EDs) use before bedtime and sleep quality in Vietnamese university students. A total of 369 university students from three departments were recruited. Participants completed self-report surveys, including demographic characteristics, lifestyle, ED-use behaviors, the Pittsburgh Sleep Quality Index, and the Center for Epidemiologic Studies Depression Scale. A total of 48.8% of the students experienced poor sleep quality, and 98.1% reported using at least one type of ED every day within two hours before bedtime. Smartphones are the most used devices (92.3%). ED usage within two hours before bedtime (p = 0.031), lack of exercise (p = 0.006), alcohol consumption (p = 0.025), and coffee intake after 4 pm (p = 0.018) were associated with poor sleep quality. ED use near bedtime for a duration longer than 30 min (p = 0.001) and depression (p < 0.001) were associated with poorer sleep quality among university students. ED use near bedtime more than 30 min was significantly associated with poorer sleep quality after adjusting depression status, exercise, and caffeine/alcohol intake in the latter part of the day. This study emphasizes the importance of adequate sleep and restriction of ED use near bedtime, which are necessary for better sleep in university students.

A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia.

Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.

Gender Differences in the Attitudes of Parents Living with Adult Children with Schizophrenia.

BACKGROUND: This paper explored the gender differences in the attitudes of parents toward taking care of their adult daughters or sons with schizophrenia, and focused on how parents define and think about the roles of their children, and how they cope with fulfilling the expected roles. METHODS: Qualitative research design and purpose sampling were used to enroll parents who had adult patients with schizophrenia at a medical center in central Taiwan. Semi-structured in-depth interviews were conducted and content analysis was used to analyze the data. RESULTS: Seven main themes emerged from the data provided by ten parents living with adult children with schizophrenia. Three themes that focused on gender difference are listed: parents continue to expect their sons with schizophrenia to carry on the family name; society as a whole expects males to be the "head of the family"; male family members are supposed to assume the responsibility of caring for siblings with schizophrenia. CONCLUSIONS: The results of the study could help clinical professionals to understand and have greater empathy with regard to the difficulties for families and the concerns of parents taking care of their children with schizophrenia in the specific context of Chinese culture, and to provide more efficient and responsive assistance.

Peripheral Neuropathy: Comparison of Symptoms and Severity Between Colorectal Cancer Survivors and Patients With Diabetes.

BACKGROUND: Peripheral neuropathy (PN) is a common symptom in colorectal cancer (CRC) survivors and patients with diabetes. However, the differences in PN symptoms between CRC survivors and patients with diabetes are not clear. OBJECTIVES: The purpose of this study was to examine the differences in PN between CRC survivors and patients with diabetes. METHODS: Secondary data were analyzed from two cross-sectional studies consisting of 81 CRC survivors and 86 patients with diabetes from two hospitals in northern and central Taiwan. Data were analyzed using descriptive statistics, analysis of covariance, and multiple logistic regression. FINDINGS: Significant differences in severity and prevalence of PN and neuropathic pain between CRC survivors and patients with diabetes were found. Patients with diabetes had significantly more severe PN and sensory PN compared to CRC survivors. In addition, the prevalence of PN and neuropathic pain was significantly higher in CRC survivors compared to patients with diabetes after control of covariates.

Effectiveness of nurses and midwives-led psychological interventions on reducing depression symptoms in the perinatal period: A systematic review and meta-analysis.

AIM: To evaluate the effectiveness of nurses and midwives-led psychological interventions on the perinatal depressive symptoms. DESIGN: A systematic review and meta-analysis based on the PRISMA guidelines. METHODS: Six databases were searched, including PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science and CINAHL. The search date range was before 30 September 2019. We used the Cochrane risk of bias tool to evaluate the quality of the included studies and Review Manager software 5.3 to conduct a meta-analysis. The data were pooled using a random-effect model. RESULTS: Studies (N = 827) were retrieved with 12 studies included. Psychological interventions provided by nurses and midwives have a significant effect on reducing perinatal depressive symptoms (RR: 0.72, 95% CI [0.64-0.82]). Among the approaches of psychological intervention, supportive counselling was the most effective (RR: 0.58, 95% CI [0.42-0.80]). The best intensity of intervention was six to eight sessions (RR: 0.66, 95% CI [0.55-0.79]).

Resilience, self-esteem, self-efficacy, social support, depression and ART adherence among people living with HIV in Sichuan, China.

ABSTRACTAIDS has had physical, psychological and social consequences on People living with HIV (PLWH) with the result that the challenges and adversity they face have significantly increased. Resilience helps individuals cope with these adversities and difficulties. For PLWH to face increased challenges and setbacks created by AIDS, they are required to have resilience. This paper presents research carried out in China aiming to examine the relationships among resilience, self-esteem, self-efficacy, social support, depression and antiretroviral therapy (ART) adherence in PLWH. A cross-sectional study using a convenience sample was conducted and 223 PLWH were recruited from 2 hospitals and 1 Center of Disease Control in Sichuan, China, from May to August 2018. The present research found that resilience was positively affected by self-esteem, self-efficacy and social support, and negatively predicted depression and positively predicted ART adherence. Resilience plays a mediating role between influential factors (self-esteem, self-efficacy and social support) and adaptive outcomes (depression and ART adherence). It suggests that resilience should be considered as a factor in intervention designed to reduce PLWH's depression and improve ART adherence. Improving self-esteem, self-efficacy and social support could enhance resilience.

A Preliminary Study of the Comfort in Patients with Leukemia Staying in a Positive Pressure Isolation Room.

Background and Aim: Patients with leukemia who are isolated in positive pressure rooms for infection prevention usually experience significant physical and psychological distress. This study aimed to examine changes in leukemia patients' comfort level during chemotherapy in isolation wards. Methods: A longitudinal survey was conducted with measures which were repeated four times. Data were collected before chemotherapy, on the first and second week after receiving chemotherapy in positive pressure isolation rooms, and on the third week in the non-isolated hematology ward. Each patient received six questionnaires measuring demographic data, comfort status, functional status, fatigue related to cancer therapy, anxiety level, and distress symptoms. A mixed model with repeated measure analysis was used to examine the changing trajectories in physical and psychological health. Results: Twenty-one patients completed the study. During the process, the highest score for comfort level was shown before chemotherapy, and this decreased from the second week under isolation. Anxiety and uncertainty (p < 0.05) declined over time, and emotional states improved during the recovery period in the third and fourth weeks outside isolation. Physical well-being (p < 0.01), cancer-related fatigue (p < 0.05), hemoglobin (p < 0.01) and white blood cell count (p < 0.05) began to rise two weeks after chemotherapy. Conclusion: Comfort levels declined after chemotherapy until the third week of treatment. Anxiety, fatigue and distress symptoms varied across the four time points of chemotherapy from isolation to return to the non-isolated ward. Health care professionals should be aware of psychological symptoms when patients are in isolation rooms, and interventions for promoting a humanized environment, quality of life, and comfort should be considered and provided along with the treatment stages of chemotherapy.

Effect of ethanol extracts of Hericium erinaceus mycelium on morphine­induced microglial migration.

Microglia serve important roles in chronic pain signal transduction pathways. Glia cells, especially microglia, seem to share mechanisms that lead to chronic pain and morphine­induced tolerance. Evidence has suggested that downregulating cytoskeleton activity in microglia provides pain relief in chronic pain and morphine tolerance. The purpose of the present study was to evaluate the effect of ethanol extracts of Hericium erinaceus (EHE) mycelium on morphine­induced BV2 microglial cell activation. BV2 cells were starved for 4 h in DMEM before being incubated with 100 ng/ml EHE for 30 min, followed by 1 µM morphine for 2 h. Subsequently, the cells were harvested and used for migration experiments and western blotting. The results showed that 1 µM morphine enhanced BV2 cell activation and chemotactic reaction, and it increased histone deacetylase 6 (HDAC6) expression and heat shock protein 90 (HSP90) deacetylation as well as HSP90 cleavage. Pretreatment with 100 ng/ml EHE significantly inhibited the morphine­stimulated effects on BV2 cells. The present study demonstrated that EHE inhibited morphine­induced BV2 activations by regulating the HDAC6/HSP90 deacetylation signal transduction pathway.