The relationship between frailty, self-efficacy, and advance care planning (ACP) remains unclear in Asia. This study examined how frailty status relates to decisional self-efficacy, ACP engagement, and advance directive completion among older adults receiving home healthcare in Taiwan.

A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (N = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4–5, n = 60), moderately frail (CFS 6, n = 83), severely frail (CFS 7, n = 147), and very severely frail (CFS 8–9, n = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.

Patients with greater frailty had lower odds of high decisional self-efficacy (CFS: 8–9: odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.14–1.07) but higher odds of ACP engagement (CFS: 6: OR = 3.38, 95% CI = 1.40–8.17; CFS: 7: OR = 2.52, 95% CI = 1.08–5.89) compared with mildly frail individuals. However, this increase did not extend linearly to the very severely frail group. Advance directive completion remained low across all frailty levels (4.8–10.0%) and was not significantly associated with frailty status.

Frailty was associated with lower decisional self-efficacy but higher readiness for ACP, revealing a divergence between perceived confidence and planning motivation. Despite greater engagement, advance directive completion remained low. Stage-sensitive, values-based approaches may help bridge the gap between intention and documentation across the frailty spectrum.

The role of pharmacists in disasters has been increasingly acknowledged, yet their responsibilities and core competencies for effective disaster management remain insufficiently defined, limiting their engagement. As pharmacists’ roles in clinical care expand, their involvement in disaster situations has similarly evolved. However, conventional pharmacy education in Taiwan currently lacks comprehensive training in disaster management. This study aims to elucidate pharmacists’ roles in disaster management and identify essential competencies, proposing a framework for advancing disaster-related education for pharmacists.

A qualitative study was conducted through semi-structured interviews from July 2024 to November 2024 with senior pharmacists from the Pharmaceutical Society of Taiwan, the Federation of Taiwan Pharmacists Association, and healthcare professionals from five disaster medical assistance teams. Participants were purposively selected, and the interviews explored pharmacists’ roles and required competencies in disaster contexts. Data were transcribed and analyzed via thematic analysis, with a second researcher contributing to enhance reliability. Preliminary findings were reviewed by participants to ensure validity.

Theoretical saturation was achieved after interviewing 15 participants. Nine categories of roles and their respective competencies were identified: understanding of disasters, self management, clinical pharmacy, pharmaceutical management, first-aid skills, psychological support, medical assistance, teamwork, and policy-making. These were consolidated into four key themes: basic disaster knowledge, pharmaceutical care in disasters, healthcare extension, and disaster management. These themes form a progressive structure for pharmacists’ education in disaster management, grounded in their professional expertise. It begins with the application and enhancement of existing knowledge based on an understanding of disasters and extends to other healthcare related services, ultimately progressing to disaster management.

The study identified the professional roles of pharmacists in disaster management, encompassing nine core competencies. This framework provides a basis for defining training objectives and structuring disaster preparedness programs for pharmacists.

Comprehensive Emergency Management (CEM) and Hazard Vulnerability Analysis (HVA) are vital topics in disaster management, particularly for hospital emergency preparedness training. Traditionally, these topics are taught through lectures, which rely heavily on the instructor’s ability, potentially limiting effectiveness. This study introduces a serious game approach as an alternative method and compares its effectiveness with lectures in fostering engagement and knowledge gain.

Participants, all hospital staff, were divided into two groups. The Lecture (L) group received a traditional lecture from an expert in hospital emergency management, while the Game (G) group engaged in a board game, “Hospital Hazard,” designed by the researchers to teach CEM and HVA concepts. Participants completed surveys before and after the sessions. The pre-survey assessed interest in learning CEM and HVA and willingness to engage in hospital CEM/HVA activities, using a 5-point Likert scale (1=very low, 5=very high). The post-survey reassessed these metrics and evaluated session enjoyment, willingness to recommend, perceived educational effectiveness, and knowledge gain, also on a 5-point scale (1=very poor, 5=very good).

The L group included 60 participants, and the G group had 109. Both groups showed significant improvement in interest and willingness after the sessions (Interest: L 3.65 → 4.08, G 3.76 → 4.30; p<0.05; Willingness: L 3.67 → 4.07, G 3.83 → 4.30; p<0.05). The G group rated the game significantly higher in terms of enjoyment, willingness to recommend, and effectiveness as a learning tool (G:L = 4.73:4.33, 4.67:4.33, 4.68:4.47, respectively; all p<0.05), with no significant difference in knowledge gain between groups (G:L = 4.46:4.40; p=0.53).

The serious game approach matched expert lectures in boosting interest, willingness, and knowledge gain among hospital staff. It outperformed lectures in enjoyment, recommendation willingness, and perceived effectiveness as a learning tool. Thoughtfully designed serious games are promising tools for teaching CEM and HVA in hospital settings.

Mass casualty incidents (MCIs) are major emergencies in emergency departments, necessitating effective training for healthcare personnel. Tabletop exercises (TTx) and functional exercises (FE) are two non-disruptive training methods that can simulate MCI responses. However, little research has compared the effectiveness of these two methods. This study aims to evaluate the effectiveness of TTx and FE as training tools for MCI preparedness.

Participants were divided into two groups: the T group (trained via TTx) and the F group (trained via FE). Both exercises simulated a train station explosion, requiring the hospital to manage 26 simulated casualties. TTx involved instructor-facilitated group discussions, while FE required role-playing in a simulated hospital setting. Participants were assessed before the exercise, immediately after, and six months post-exercise. Evaluations included confidence in MCI response, willingness to attend future training, willingness to participate in real MCIs, knowledge of disaster medicine, and familiarity with MCI response plans. Data were analyzed using ANOVA and paired t-tests to assess short- and long-term effects. Additionally, participants provided feedback on the factors that most contributed to their learning.

Both exercises significantly improved confidence in MCI response, with TTx having more sustained effects. FE increased willingness to attend future training and participate in real MCIs, though effects diminished after six months. Neither exercise significantly affected disaster medicine knowledge. Familiarity with MCI response plans improved in both groups but returned to baseline after six months. Participants rated both exercises as valuable learning tools, citing scenario-based learning, greater engagement, interactivity, and real-time feedback as key factors.

TTx and FE are both valuable for hospital disaster preparedness, with each offering unique advantages. Hospitals should select the exercise format that best suits their staff and needs. Regular re-training within six months may be required to sustain preparedness.

In environments impacted by extreme disasters, the prevalence of human-made disasters and high-risk situations has been increasing. It has become an important issue to enhance situational awareness and strengthen response capabilities for medical professionals, building upon their existing expertise, from the perspective of NGOs. From 2022 to 2024, the organization held over eight training sessions with more than 150 participants, lasting from 2 to 5 days each. All participants were healthcare professionals. The training included situational awareness, basic battlefield injury management, and advanced damage-control resuscitation, combined with highly realistic, scenario-based exercises to enhance situational awareness and response capabilities.

In post-training interviews, all participants reported that the training helped them develop new logical thinking and perspectives. The scenario-based exercises enhanced their response speed and adaptability. The skills acquired were applicable not only in high-risk environments but also in their daily work settings. High-risk environments are not limited to humanitarian conflicts; they can also occur in everyday settings. Given the current global instability, similar training courses conducted by NGOs can effectively improve the situational awareness and response abilities of healthcare professionals.

The occurrence of disasters often has a tremendous impact on communities. In large-scale disasters, affected residents often need to rely on self-rescue before emergency response resources arrive. Therefore, enhancing the disaster response capability of community members is increasingly important, especially in light of the current extreme weather conditions.

From 2020 to 2024, the organization conducted 15 training sessions for frontline community responders, with over 1,000 participants in total. The training included classroom lectures, hands-on practice, and scenario-based drills to increase familiarity. A post-training assessment was conducted to ensure that participants understood and were proficient in the skills and knowledge taught in the course.

In the final assessment, all participants passed, achieving a 100% success rate. In the technical skills section, participants were able to independently complete all tasks. During the lecture sessions, instructors engaged with participants in comprehensive drills to confirm their retention of the course content.

Building community resilience is not a short-term endeavor with immediate results. Starting from basic first aid education and gradually expanding to all-hazard response training, the long-term planning and implementation of frontline community responder training can strengthen the community’s comprehensive response capabilities, equipping them to effectively handle both natural and human-made disasters in the future.

Flowcharts and checklists are frequently used by hospitals as reference tools during disaster responses. However, there is a lack of research comparing their effectiveness in aiding responders. This study aims to evaluate whether flowcharts or checklists provide better support to personnel during hospital emergencies.

The study involved 24 fire drills in a hospital ward, with groups of 6–7 participants responding to a simulated fire. The participants were divided into six groups. Three groups used flowcharts (F groups), and three used checklists (C groups). Each type of group was further subdivided: F1 and C1 received only the tool (flowchart or checklist) without explanation; F2 and C2 received the tool along with an explanation of how to use it; F3 and C3 were assigned a designated person responsible for using the tool. Performance was assessed in three areas: fire response, medical response, and participant evaluation. Fire and medical response were each evaluated on nine specific tasks, scored from 0 (not completed) to 2 (fully completed). Participant feedback was measured using a 5-point Likert scale. The differences among the groups were analyzed using ANOVA.

Fire response scores ranged from 1.00 to 1.31, and medical response scores ranged from 1.06 to 1.31. There were no significant differences in fire (P=0.09) or medical (P=0.83) response scores among the six groups. However, participant evaluations showed significant differences between F1 and F2 groups (P=0.04), with overall ratings ranging from 4.33 to 4.95.

The study found no significant difference in fire or medical response performance between flowchart and checklist users. However, providing explanations improved participant satisfaction with flowcharts. Both tools can effectively aid disaster response personnel.

To synthesize the available experimental study evidence to estimate the effects of ketamine on suicide ideation (SI) in high-risk individuals.

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Double-blind randomized controlled trials and open-label studies investigating the safety and effectiveness of ketamine on SI published up to October 2025 were identified. Data were pooled using random-effects meta-analysis. The main outcome was standardized mean difference on SI in high-risk individuals. Secondary outcomes were the percentage of adverse events and the moderator effects.

We identified 21 studies with a total of 927 participants meeting our inclusion criteria. The pooled effect size for the reduction of SI after ketamine treatment was significant and clinically meaningful (large effect size of −1.40, 95% confidence interval: −2.15 to −0.66, P < 0.001, low–quality evidence). Dissociation (38.8%, P = 0.014), nausea (31.6%, P < 0.001), dizziness (24.7%, P = 0.003), headache (22.0%, P = 0.011) and anxiety (15.8%, P < 0.001) were the frequently reported adverse events. Moderator analyses indicated that the effect was higher in younger individuals and those with severe SI.

Our findings highlight the effectiveness of ketamine in reducing SI in high-risk individuals, especially younger individuals and those with severe ideation. Nonetheless, additional research is required to better understand optimal dosing regimens and the potential long-term effects of ketamine treatment.

Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.

The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.

In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60–2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31–1.98) in the medium SDH group and 2.19 (95% CI: 1.78–2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.

Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.