Associations Between Obstructive Sleep Apnea Syndrome, Dry Eye Disease, and CPAP Usage Among Taiwanese Patients: A Retrospective Analysis.

Study Objectives: To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED. Methods: This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer's test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren's syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared. Results: In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47-10.49, P = 0.006). Conclusion: OSA severity is associated with DED and might be attributed to the use of CPAP.

Development of the Acute Care Nurse Practitioner Competencies Scale: An Exploratory and Confirmatory Factor Analysis.

BACKGROUND: Nurse practitioners (NPs) play a vital role in healthcare, particularly in acute care settings in Taiwan. The professional competencies of NPs are essential for providing safe and effective care to patients. To date, no measurement tool is available for assessing the clinical competencies of NPs in acute care practices. PURPOSE: The aim of this study was to develop and investigate the psychometric properties of the Acute Care Nurse Practitioner Competencies Scale (ACNPCS). METHODS: Mixed-method research was employed using samples of experienced NPs. First, we used a focus group of seven experienced NPs who worked for medical centers, community hospitals, and regional hospitals to identify clinical competencies content. Second, we implemented consensus validation using two rounds of the Delphi study and revised it to a 39-item ACNPCS. Third, we conducted content validity with nine NP experts and modified the competency content to 36 items. Finally, we conducted a national survey of 390 NPs from 125 hospitals to determine the extent to which the NP competency content relates to their clinical practice. To examine the reliability of the tool, we tested the internal consistency reliability and test-retest reliability. Exploratory factor analysis, confirmatory factor analysis, and known-group validity were used to test the construct validity of the ACNPCS. RESULTS: The Cronbach's alpha coefficient for the overall scale was .92, with subscale coefficients ranging from .71 to .89. Test-retest reliability showed the two scores of the ACNPCS on the two occasions tested to be highly correlated ( r = .85, p < .001). Exploratory factor analysis revealed that the scale had six factors: providing healthcare, evaluating care, collaboration, education, care quality/research, and leadership/professionalism. Factor loadings for each factor item ranged from .50 to .80 and explained 72.53% of the total variance in the NPs' competencies. Confirmatory factor analysis indicated that the six-factor model showed satisfactory model fit (χ 2 = 780.54, p < .01), and the fit indices met the standards for adequate fit (goodness-of-fit index = .90, comparative fit index = .98, Tucker-Lewis index = .97, root mean square error of approximation = .04, and standardized root mean residual = .04). Known-group validity revealed that the total scores for novice NPs differed significantly from those of expert NPs in terms of the competencies ( t = 3.26, p < .001). These results validated the psychometric soundness of the newly developed ACNPCS. CONCLUSIONS: The newly developed ACNPCS exhibited satisfactory reliability and validity, supporting the use of the ACNPCS as a tool to assess the clinical competencies of NPs in acute care settings.

Framing the virus: The political, economic, biomedical and social understandings of the COVID-19 in Taiwan.

The purpose of this paper is to study how people use texts and languages to interpret or make sense of the COVID-19 pandemic. We draw on the theoretical literature of framing perspectives to formulate our arguments that consider the virus a socially constructed reality. We use Taiwan as an empirical case study, using topic modeling analysis of newspaper articles. Our findings show that the language of the COVID-19 coverage combines the four frames of political evaluation, economic impact, biomedical science and social life in varying proportions. These frames are subject to changes in pandemic conditions. Implications for theory and practice are presented.

The Clinical and Economic Impact of a Nonavalent Versus Bivalent Human Papillomavirus National Vaccination Program in Taiwan.

OBJECTIVES: This study aimed to estimate the epidemiologic and economic impact of a nonavalent human papillomavirus (HPV) vaccination program for 13- to 14-year-old females compared with that of the bivalent vaccine in Taiwan. METHODS: A previously developed dynamic transmission model for the nonavalent HPV vaccine was adapted to the Taiwan setting. The natural history of cervical cancer and genital warts was simulated by the HPV model assuming an 80% vaccination coverage rate in girls aged 13 to 14 years of age with a 2-dose schedule for the nonavalent and bivalent HPV vaccines. A lifetime duration of vaccine protection was assumed for the HPV vaccine types. RESULTS: The model estimated that the nonavalent HPV vaccine would prevent an additional 15 951 cervical cancer cases, 6600 cervical cancer-related deaths, 176 702 grade 2 or grade 3 cervical intraepithelial neoplasia cases, 103 959 grade 1 cervical intraepithelial neoplasia cases, and 1 115 317 genital warts cases compared with the bivalent HPV vaccine. The nonavalent HPV vaccination program was projected to cost an additional New Taiwan dollars (NTD) 675.21 per person and to produce an additional 0.00271 quality-adjusted life-year per person over 100 years compared with the bivalent HPV vaccine. Thus, the incremental cost-effectiveness ratio of the nonavalent HPV vaccine versus the bivalent HPV vaccine was NTD 249 462/quality-adjusted life-year. CONCLUSIONS: A nonavalent HPV vaccination program for 13- to 14-year-old girls would have additional public health and economic impacts and would be highly cost-effective compared with the bivalent HPV vaccine, relative to per capita gross domestic product, which is estimated at NTD 746 526 for Taiwan.

An Initial Study on Multi-Point Laser Acupuncture Based on 2-D Galvo Mirror.

Currently, the majority of commercially available laser acupuncture instruments are still hand-held and only support single-point stimulation. Simultaneous multi-point stimulation improves the therapeutic efficacy of laser acupuncture by stimulating multiple acupoints at the same time. A "2-dimensional (2-D) galvo mirror" was utilized as a positioning laser acupuncture device for multi-acupoints stimulation. Due to its ability to perform 2-D fast scanning, a single laser beam was reflected by the mirror and stimulated multiple acupuncture points simultaneously. This introduction to the new system, presents its architecture, and shows some initial results. This initial stage of development was focused on the acupoints of the human forearm. This proposed system is the first low-cost, noncontact laser acupuncture system that enables continuous multi-acupoint stimulation with a single laser beam. Notably, it is technically feasible to develop this technique into a whole-body laser acupuncture stimulation system.

Intra and inter: Alterations in functional brain resting-state networks in patients with functional constipation.

Background: Functional constipation (FCon), is a symptom-based functional gastrointestinal disorder without an organic etiology and altering brain structure and function. However, previous studies mainly focused on isolated brain regions involved in brain plasticity. Therefore, little is known about the altered large-scale interaction of brain networks in FCon. Methods: For this study, we recruited 20 patients with FCon and 20 healthy controls. We used group independent component analysis to identify resting-state networks (RSNs) and documented intra- and inter-network alterations in the RSNs of the patients with FCon. Results: We found 14 independent RSNs. Differences in the intra-networks included decreased activities in the bilateral caudate of RSN 3 (strongly related to emotional and autonomic processes) and decreased activities in the left precuneus of RSN 10 (default mode network). Notably, the patients with FCon exhibited significantly decreased interactive connectivity between RSNs, mostly involving the connections to the visual perception network (RSN 7-9). Conclusion: Compared with healthy controls, patients with FCon had extensive brain plastic changes within and across related RSNs. Furthermore, the macroscopic brain alterations in FCon were associated with interoceptive abilities, emotion processing, and sensorimotor control. These insights could therefore lead to the development of new treatment strategies for FCon.

Reliability and Validity of a Chinese Version of the Cohen-Mansfield Agitation Inventory-Short Form in Assessing Agitated Behavior.

BACKGROUND: Patients with dementia often present agitated behaviors. The Cohen-Mansfield Agitation Inventory-short form (CMAI-SF) is one of the most widely used instruments to evaluate agitated behaviors that affect patients' quality of life and impose burden on caregivers. However, there is no simplified Chinese version of the CMAI-SF (C-CMAI-SF) in clinical settings. PURPOSE: This study aimed to develop a Chinese version of the C-CMAI-SF and examine its validity and reliability. METHODS: This cross-sectional study included three phases. In Phase I, the original CMAI-SF was translated to Chinese. In Phase II, experts were invited to examine the content validity index (CVI). Phase III was conducted to test the validity and reliability of the C-CMAI-SF. RESULTS: The scale showed good validity and reliability with a scale-level CVI of 0.89, Cronbach's alpha (measure of internal consistency) of 0.874, and test-retest correlation coefficient of 0.902 (for 257 individuals). Using factor analysis, three factors were identified. Regarding concurrent validity, the C-CMAI-SF score was correlated with the Neuropsychiatric Inventory (agitation aggression subscale) and the Cornell Scale for Depression in Dementia (agitation subscale). CONCLUSIONS: The study demonstrated that the C-CMAI-SF is a valid and reliable instrument for evaluating agitated behaviors in people with dementia. RELEVANCE TO CLINICAL PRACTICE: The C-CMAI-SF is an easy and quick tool used to identify and evaluate agitated behaviors in busy clinical settings.

Retrospective Evaluation of Discharge Planning Linked to a Long-Term Care 2.0 Project in a Medical Center.

BACKGROUND: Although there are several studies on discharge planning and long-term care systems in individual programs, research on the connection between discharge planning and the usage of long-term care is scanty. This study aims to evaluate the nature of the association between discharge planning (DP) and long-term care (LTC) and whether the utilization of LTC services improved after being discharged. METHODS: This was a single-center retrospective medical record review study. Secondary data analysis was conducted of DP-LTC participation data between 2018 and 2019. The objectives were to clarify the distinct characteristics of each part of the service to explore the utility rate by overall users and users with willingness and to determine the factors influencing their usage. Medical claims were used to identify inpatients receiving discharge services, and data were matched with LTC system engagement data (n = 2155). Backward stepwise regression was used to explore the attributes associated with each type of service use. RESULTS: A total of 94% (2042/2155) of inpatients expressed a perceived need for LTC services, of which 14% (285/2042) were users of LTC services after discharge. When assessed by case-mix system (CMS) and willingness to use services during hospitalization, inpatients had higher rates of service utilization after discharge. Using LTC services was most likely to be associated with obesity, disability, high CMS level, higher education, and women. CONCLUSION: The study confirms that the utilization of LTC services has improved under the integrated DP-LTC system. The gap between willing and actual users is worth considering. In the assessment stage, special attention should be paid to the service needs of persons with BMI ≥ 27 and disabilities. Future research with a larger sample could comprehensively evaluate the impact of integrated DP services on the use of LTC 2.0 service resources.

The Effectiveness of a Critical Appraisal Skills Workshop 6 Months After Nurses' Participation.

Background The aim of this study was to explore whether nursing staff retained knowledge, self-confidence, and attitudes 6 months after participating in a critical appraisal skills workshop. Method A retrospective matched case-control study was conducted to ascertain the effects of this training on the ability to appraise literature. Results Mean scores on the critical appraisal knowledge test, self-confidence, and attitudes were significantly higher in the case group compared to the control group (p < .001, p < .05, and p = .031, respectively). Conclusion Six months after the workshop, critical appraisal knowledge, self-confidence, and attitudes remained improved among the nursing staff who participated. This indicates that the workshop was effective for learning and can be used for clinical training. [J Contin Educ Nurs. 2022;53(8):372-378.].

Colloidal silver-based lateral flow immunoassay for detection of profenofos pesticide residue in vegetables.

A colloidal silver nanoparticle (AgNP)-based lateral flow immunoassay (LFIA) was evaluated in terms of the rapid detection of profenofos (PEO) pesticide residue in vegetables. Colloidal AgNPs, of a diameter of approximately 20 nm, were surface-modified with trisodium citrate dehydrate (TSC) in order to improve their stability and dispersion. An anti-profenofos polyclonal antibody (pAb) was successfully immobilized on the surface of the AgNPs by ionic interaction and characterized using UV-vis, SEM, TEM, FTIR and XPS analyses. Surface modification of Ag-pAb conjugates of varying pH, pAb content and cross-reactivity was employed to design and prepare labels for use in an LFIA to examine whether these factors affect the performance of the assay. The visible detection limit and optical detection limit of the PEO test strip were 0.20 and 0.01 ppm, respectively, in PEO standard solution. This assay showed no cross-reaction with omethoate, methamidophos or pyraclofos. Finally, the PEO test strip was effectively applied for the detection of PEO in liquid vegetables A and B, with optical detection limits of 0.09 and 0.075 ppm, respectively.

Description of Acaralox latifolia n. sp. (Acari: Trombidiformes: Eriophyoidea) on water bamboo from Taiwan.

Water bamboo, Zizania latifolia (Griseb.), Poaceae, is the major crop in Puli Township, Taiwan. Following some unknown mite infestations causing leaf curling symptoms first observed in 2018, water bamboos experienced a dramatic crop yield. Our morphological evaluation revealed their infestation with a new species of eriophyoid mite, Acaralox latifolia n. sp. (Acari: Trombidiformes: Eriophyoidea). Here, we described and illustrated this new species and provided its scanning electronic micrographs and DNA sequences of COI and ITS regions. This is the first record of the genus Acaralox from Taiwan.

Clinical outcomes and prognostic factors for prolonged mechanical ventilation in patients with acute stroke and brain trauma.

BACKGROUND/PURPOSE: Neurological dysfunction is a common condition necessitating prolonged mechanical ventilation (PMV). We investigated the clinical features and outcomes of patients with acute neurological diseases requiring PMV. METHODS: This retrospective observational study was conducted at the Respiratory Care Center (RCC) of Chang Gung Memorial Hospital, Taiwan, between January 2011 and January 2014. The main outcome was weaning success, defined as successful withdrawal from mechanical ventilator support for more than 5 days. RESULTS: The study included 103 patients with acute stroke and brain trauma receiving PMV. Weaning success was reported in 63 (61%) patients and weaning failure was reported in 40 (39%) patients. Patients in the weaning failure group were older and had a lower RCC Glasgow Coma Scale (GCS) score (6.0 vs 7.9, p = 0.005), lower albumin level (2.8 vs 3.1, p = 0.015), longer RCC stay (28.7 vs 21.3 days, p = 0.017), and higher in-hospital mortality rate (47% vs 9%, p < 0.01). Multivariate analysis revealed that reduced RCC GCS score is an independent prognostic factor for weaning failure (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.05-1.46, p = 0.016) and that per unit increase of RCC GCS score is associated with a lower risk of in-hospital mortality (OR = 0.83, 95% CI = 0.70-0.96, p = 0.019). CONCLUSION: Reduced RCC GCS score is an independent prognostic factor for weaning failure, and is associated with increased in-hospital mortality rates in patients with acute stroke and brain trauma requiring PMV.

Timing of the first cannulation and survival of arteriovenous grafts in hemodialysis patients: a multicenter retrospective cohort study.

Arteriovenous graft (AVG) is an important vascular access route in hemodialysis patients. The optimal waiting time between AVG creation and the first cannulation is still undetermined, therefore the current study investigated the association between ideal timing for cannulation and AVG survival. This retrospective cohort study used data from the Taiwan National Health Insurance Database, which included 6,493 hemodialysis patients with AVGs between July 1st 2008 and June 30th 2012. The waiting cannulation time was defined as the time from the date of shunt creation to the first successful cannulation. Patients were categorized according to the waiting cannulation time of their AVGs as follows: ≤30 days, between 31 and 90 days, between 91 and 180 days, and >180 days. The primary outcome was functional cumulative survival, measured as the time from the first cannulation to shunt abandonment. The AVGs which were cannulated between 31 and 90 days (reference group) after construction had significantly superior functional cumulative survival compared with those cannulated ≤30 days (adjusted HR = 1.651 with 95% CI 1.482-1.839; p < 0.0001) and >180 days (adjusted HR = 1.197 with 95% CI 1.012-1.417; p = 0.0363) after construction. An analysis of the hazard ratios in patients with different demographic characteristics, revealed that the functional cumulative survival of AVGs in most groups was better when they received cannulation >30 days after construction. Consequently, in order to achieve the best long-term survival, AVGs should be cannulated at least 1 month after construction, but you should avoid waiting for >3 months.

The development and pilot testing of an ACP simulation-based communication-training program: Feasibility and acceptability.

The lack of knowledge of advance care planning and training of communication skills among nurses in Taiwan is one of the main reasons for the low rate of advance directive signing. However, there is no specific and effective solution to this problem. The purposes of this study were (1) to develop and pilot testing of an advance care planning simulation-based communication training program and (2) to evaluate the feasibility and acceptability of the program. This study was conducted in three phases. Phase 1: Developing an advance care planning simulation-based communication training program; Phase 2: Conducting a pilot test; Phase 3: Evaluating the feasibility and acceptability of the program. Twelve convenient participants from a medical center in central Taiwan were selected. The participants believed that team-based learning was beneficial for several reasons. First, it helped to clarify the participants' understanding of advance care planning and improve their communication skills. Second, role-playing, as one of the components, was helpful for discovering their own shortcomings in communication skills while debriefing enabled them to identify their blind spots in the communication process. Finally, the reflection log documented their weekly performance so they were able to reflect upon their weekly performance, improve their performance, and become more confident. All twelve participants signed the consent form and completed the whole training program. The participants were satisfied with the program, affirming that the timing and content of the program were appropriate and that the expected learning outcomes could be achieved. According to participant feedback, the program was beneficial in improving their knowledge of advance care planning and confidence in communication. Thus, it is feasible and acceptable to introduce communication of advance care planning programs into the staff training protocols of healthcare organizations. Clinical trial registration: NCT04312295.

Efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction in Taiwan.

The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73-1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3-8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33-1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21-0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification.

Effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms in menopausal women: A meta-analysis.

OBJECTIVE: Menopause is a normal physiological process experienced by women, but it is often accompanied by physical and emotional symptoms that may negatively affect quality of life. This meta-analysis aimed to evaluate the effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms by examining randomized controlled trials. METHODS: A systematic search was conducted across six electronic databases to collect relevant articles published up to June 30, 2020. The articles' quality was assessed using the modified Jadad scale. We performed a meta-analysis with Review Manager 5.3, calculating 95% confidence intervals and standardized mean differences, and conducted sensitivity analyses. RESULTS: The meta-analysis of five randomized controlled trials included 475 participants. The results indicated that the mindfulness-based intervention groups showed significant improvements in total quality of life and vasomotor and physical quality of life, compared to control groups (standardized mean differences range: from -0.48 to -0.68, all ps < 0.05). After the sensitivity analyses, evidence of heterogeneity remained. Insufficient data prevented conducting a meta-analysis with the sexual subscale of MENQOL or on vasomotor symptoms of menopause. CONCLUSION: For menopausal women, mindfulness-based interventions may improve quality of life (except for psychological and sexual subscales). However, there is insufficient evidence to analyze whether such interventions can reduce vasomotor-related menopausal symptoms. Although heterogeneity should be carefully assessed, mindfulness-based interventions may be a novel approach for improving women's overall quality of life during menopause. However, further research is needed to verify these effects.

Organizational empowerment and practice outcomes of acute care nurse practitioners in Taiwan: A national survey.

BACKGROUND: Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave. PURPOSE: This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices. METHODOLOGICAL ORIENTATION: This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression. RESULTS: The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction. CONCLUSIONS: Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan. IMPLICATIONS FOR PRACTIC: To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system.

Integrating Muscle Health in Predicting the Risk of Asymptomatic Vertebral Fracture in Older Adults.

BACKGROUND: The utility of muscle health for predicting asymptomatic vertebral fracture (VF) is uncertain. We aimed to determine the effects of muscle health on bone quantity and quality in the older adults and to integrate these factors into a predictive model for VF. METHODS: We prospectively recruited participants with a body mass index <37 kg/m2. The total lean mass (TLM), appendicular skeletal muscle index, presence of sarcopenia, and bone mineral density were determined by dual-energy X-ray absorptiometry, and bone quality by the trabecular bone score (TBS). VF was diagnosed based on spine radiography. RESULTS: A total of 414 females and 186 males were included; 257 participants had VF. Lower TLM was significantly associated with poorer bone quantity and quality in both males and females. A low TBS (OR: 11.302, p = 0.028) and sarcopenia (Odds ratio (OR): 2.820, p = 0.002) were significant predictors of VF in males, but not bone quantity. Moreover, integrating TBS and sarcopenia into the predictive model improved its performance. CONCLUSIONS: Although TLM was associated with bone quantity and quality in both sexes, sarcopenia and a low TBS were significant predictors of asymptomatic VF only in male participants.

Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial.

AIM: The purpose of this study was to investigate the effectiveness of empathic caring on sleep quality, depression, stress, and social support in women with recurrent miscarriage. MATERIALS AND METHODS: Sixty-two eligible women were randomly assigned to either the experimental group (n = 31), which received three face-to-face nursing counseling sessions, or the control group (n = 31). Outcome measures included the Pittsburgh Sleep Quality Index, Edinburgh Prenatal Depression Scale, Perceived Stress Scale, and Interpersonal Support Evaluation List. RESULTS: Paired-sample t-tests revealed that, after receiving nursing counseling, the participants in the experimental group showed significant decreases in stress and depression. However, no significant mean differences were found in the control group between the pretest and the 12-week posttest for any of the four outcome measures. CONCLUSION: Clinical healthcare professionals may incorporate empathic caring into health-promotion protocols to assist women with recurrent miscarriage to improve their psychosocial health.