Effects of an earplug placement intervention on sleep quality in patients in a medical intensive care unit: A randomized controlled trial.

AIMS: This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non-ventilated intensive care unit patients. METHODS: A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6-sulfatoxymelatonin levels, relaxation responses measured using the Richards-Campbell Sleep Questionnaire, liquid chromatography-mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. RESULTS: Overall, 28.03% of participants showed virtually no 6-sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6-sulfatoxymelatonin and vital signs. CONCLUSIONS: The effects of using earplugs alone on sleep quality, urinary 6-sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality.

A novel diagnostic nomogram based on serological and ultrasound findings for preoperative prediction of malignancy in patients with ovarian masses.

OBJECTIVE: To develop a novel diagnostic nomogram model to predict malignancy in patients with ovarian masses. METHODS: In total, 1277 patients with ovarian masses were retrospectively analyzed. Receiver operating characteristic (ROC) analysis was performed to identify valuable predictive factors. Univariate and multivariate logistic regression analyses were used to identify risk factors for ovarian cancer. Subsequently, a predictive nomogram model was developed. The performance of the nomogram model was assessed by its calibration and discrimination in a validation cohort. Decision curve analysis (DCA) was applied to assess the clinical net benefit of the model. RESULTS: Overall, 496 patients (38.8%) had ovarian cancer. Eighteen parameters were significantly different between the malignant and benign groups. Five parameters were identified as being most optimal for predicting malignancy, including age, carbohydrate antigen 125, fibrinogen-to-albumin ratio, monocyte-to-lymphocyte ratio, and ultrasound result. These parameters were incorporated to establish a nomogram model, and this model exhibited an area under the ROC curve (AUC) of 0.937 (95% confidence interval [CI], 0.920-0.954). The model was also well calibrated in the validation cohort and showed an AUC of 0.925 (95%CI, 0.896-0.953) at the cut-off point of 0.298. DCA confirmed that the nomogram model achieved the best clinical utility with almost the entire range of threshold probabilities. The model has demonstrated superior efficacy in predicting malignancy compared to currently available models, including the risk of ovarian malignancy algorithm, copenhagen index, and the risk of malignancy index. More importantly, the nomogram established here showed potential value in identification of early-stage ovarian cancer. CONCLUSION: The cost-effective and easily accessible nomogram model exhibited favorable accuracy for preoperative prediction of malignancy in patients with ovarian masses, even at early stages.

CHD1L promotes EOC cell invasiveness and metastasis via the regulation of METAP2.

Chromodomain helicase DNA binding protein 1-like (CHD1L) gene has been proposed to play an oncogenic role in human hepatocellular carcinoma. Previously we reported that CHD1L overexpression is significantly associated with the metastasis proceeding of epithelial ovarian cancer (EOC), and may predict a poor prognosis in EOC patients. However, the potential oncogenic mechanisms by which CHD1L acts in EOC remain unclear. To elucidate the oncogenic function of CHD1L, we carried out a series of in vitro assays, with effects of CHD1L ectogenic overexpression and silencing being determined in EOC cell lines (HO8910, A2780 and ES2). Real-time PCR and Western blotting analyses were used to identify potential downstream targets of CHD1L in the process of EOC invasion and metastasis. In ovarian carcinoma HO8910 cell lines, ectopic overexpression of CHD1L substantially induced the invasive and metastasis ability of the cancer cells in vitro. In contrast, knockdown of CHD1L using shRNA inhibited cell invasion in vitro in ovarian carcinoma A2780 and ES2 cell lines. We also demonstrated that methionyl aminopeptidase 2 (METAP2) was a downstream target of CHD1L in EOC, and we found a significant, positive correlation between the expression of CHD1L and METAP2 in EOC tissues (P<0.05). Our findings indicate that CHD1L plays a potential role in the inducement of EOC cancer cell invasion and/or metastasis via the regulation of METAP2 expression and suggests that CHD1L inhibition may provide a potential target for therapeutic intervention in human EOC.

Resilience and coping styles as predictors of health outcomes in breast cancer patients: A structural equation modelling analysis.

INTRODUCTION: Resilience has been associated with psychological adaptation to many threatening life events, but previous studies have rarely analysed the integrated relationships among demographic and disease characteristics and various health outcomes in Taiwan. This study examined the associations among demographic factors, disease characteristics, resilience, coping styles and adverse health outcomes, including anxiety and depressive symptoms and sleep disorders. METHODS: A descriptive, cross-sectional study design was used. Data from a convenience sample of 175 patients with breast cancer aged 20 years or older were collected using a self-reported questionnaire. A structural equation modelling approach was applied to examine the relationships among the variables. RESULTS: The results showed that greater resilience was related to fewer depressive symptoms, lower anxiety levels and better sleep quality. All three coping styles, including active coping, minimising the situation and avoidance coping, were negatively correlated with depressive symptoms, but only active coping was significantly correlated with sleep quality. Resilience had a direct effect on depressive symptoms, anxiety and sleep disorders. Furthermore, a mediating effect of resilience was observed on the relationship between marital satisfaction and depressive symptoms. CONCLUSION: Resilience can strengthen breast cancer-related adaptation. Additionally, breast cancer survivors who used mainly the active and minimising coping styles tended to experience fewer depressive symptoms.

Insomnia and its associated factors in incarcerated adults: A cross-sectional study.

No evidence exists in the literature concerning the prevalence of insomnia and its associated risk factors among prison inmates in Taiwan. The aim of the present study was to determine the prevalence and factors associated with insomnia among inmates in a large prison in Taiwan. A cross-sectional anonymous questionnaire survey was conducted at a prison. The participants were 1490 male inmates. Participants completed the self-reported Insomnia Severity Index-Chinese version questionnaire, and the sociodemographic and psychological distress questionnaires for the study. Multivariate logistic regression was used to analyze and compare the differences between inmates with and without insomnia. The prevalence of insomnia was 26.9%. The study determined that anxiety, self-rated health status, and religious beliefs were independent predictors of insomnia in male inmates. Given the adverse effect of insomnia and its social consequences, it is crucial to develop prevention programs to mitigate insomnia in inmates.

Effects of individual characteristics on insomnia severity trajectory among nurses: A prospective longitudinal study.

AIMS: To examine the longitudinal effects of individual characteristics on the change pattern of insomnia and the association of occupational stress with insomnia over time in newly graduated nurses. BACKGROUND: The association between individual factors and insomnia in nurses is inconclusive. Longitudinal research on insomnia in newly graduated nurses is limited. METHODS: This prospective longitudinal study included 200 participants generating 800 observations of insomnia severity during their first year of nursing. We employed growth mixture modelling for data analyses. Both time-varying covariate (occupational stress) and time-invariant covariates (nurses' characteristics) were entered into the model simultaneously. RESULTS: Nurses had a homogeneous insomnia trajectory during the whole year of survey. The educational level significantly predicted the growth rate of insomnia severity among nurses. Occupational stress at each time point was significantly associated with worse insomnia across time points (all p < .001). CONCLUSIONS: Nurses with a baccalaureate degree were more resilient to the development of severe insomnia. Additional studies have an opportunity to investigate the reason for the effects of the educational level on the pattern of insomnia. IMPLICATIONS FOR NURSING MANAGEMENT: Considering nurses' occupational stress and educational level would lead more effective management of stress and insomnia in newly graduated nurses.

Use of integrative medicine approaches for treating adults with sleep disturbances.

AIM: This study determined the prevalence, perceived efficacy, and influencing factors and evaluated the sources of information as well as the barriers and facilitators for the use of integrative medicine approaches (IMA) within the previous 12 months to treat adults with sleep disturbances. BACKGROUND: No studies have assessed the use of integrative medicine approaches in adults with sleep disturbances. METHODS: A cross-sectional postal survey was conducted. Adults with sleep disturbances were purposively selected from the sleep center of a hospital in Taiwan. Binary logistic regression was used to analyze and compare the differences between groups of use and non-use IMA. RESULTS: The response rate was 94.5% (n = 515). The prevalence for the use of integrative medicine approaches was 53.4% (n = 275). The most prevalent IMA was music. However, the most perceivably efficacious integrative medicine approaches was acupressure, followed by music and meditation. Independent explanatory variables were educational attainment, the number of chronic diseases/symptoms, and healthy lifestyles for the use of IMA. The most common source of information was television/radio. The top facilitator and barrier for the use of integrative medicine approaches were side effects of sleeping pills and limited accessibility. CONCLUSIONS: IMA are used by a considerable proportion of adults for treating sleep disturbances in Taiwan. The findings of this study identified the significant explanatory variables of IMA use and provided a fundamental understanding the aspects of IMA use in the adults with sleep disturbances is particularly important for health care providers in practice associated with their patients.

Depression and Health-Related Quality of Life and Their Association With Resourcefulness in Survivors of Prostate Cancer.

OBJECTIVE: This study aimed to identify the determinants of depressive symptoms (DSs) and health-related quality of life (HRQOL) in survivors of prostate cancer (PC). METHODS: This study used a descriptive, correlational design to assess a sample of 133 individuals with PC. The participants were face-to-face interviewed to collect demographic data and disease characteristics, assess self-control schedule, and survey health status. Correlation analysis, Student's t-test, ANOVA, and regression analysis were applied. RESULTS: Over half the patients had depressive symptoms, and 96.1% had erectile dysfunction. Lack of resourcefulness was found to decrease PC-specific quality of life (PCQOL) and physical quality of life (PQOL). The participants who were more resourceful showed a better mental quality of life (MQOL) and PQOL (r=0.53**; r=0.41**) and fewer DSs (r=-0.52**). Most participants were stage II and IV, and there were significantly different effects on PQOL and MQOL related to cancer stage. Regarding the different outcomes of various therapies, the findings suggested that survivors of PC who underwent radical prostatectomy were more likely to have a better MQOL than those who underwent other treatments. In addition, resourcefulness had mediating effects on pain, PQOL/MQOL, and DSs in the patients with PC. CONCLUSIONS: Good mental health and resourcefulness can help patients with PC reduce pain and enhance positive thinking and may augment PQOL and MQOL.

Effects of motivational enhancement therapy plus cognitive behaviour therapy on depressive symptoms and health-related quality of life in adults with type II diabetes mellitus: a randomised controlled trial.

OBJECTIVE: This paper evaluates the effectiveness of motivational enhancement therapy plus cognitive behavioural therapy on depressive symptoms, glycosylated haemoglobin, fasting glucose, body mass index (BMI), and health-related quality of life in type II diabetes patients. METHODS: A controlled trial was conducted to compare patients who received the behavioural intervention with untreated controls on measures of health outcomes. A total of 31 intervention group participants and 30 controls were selected from patients that met the inclusion criteria from a hospital-based endocrinology outpatient department. The outcome measures including depressive symptoms, glycosylated haemoglobin, fasting glucose, BMI, and both physical and mental quality of life were collected before (T1), after (T2), and after 90 days (T3) following the intervention. RESULTS: The experimental group showed a significant reduction in glycosylated haemoglobin, fasting glucose, and depressive symptoms and a significant increase in physical quality of life and mental quality of life at T2 and T3, while patients in the control group with usual care showed no changes over time. CONCLUSION: The behavioural intervention facilitated a significant improvement in psychological adjustment and glycemic control, thus strengthening diabetes control skills and leading to healthy outcomes. It is feasible that nurses and psychiatrists can deliver the behavioural intervention for diabetes patients to decrease their depressive symptoms. Sharing discussion and problem-solving experiences is particularly helpful method for self-control, and these will be beneficially influential on further research.

Comparing the effects of music and exercise with music for older adults with insomnia.

AIM: To examine the effects of a soothing music intervention before bedtime and a treadmill brisk walking exercise combined with music in the evening on sleep quality of sedentary older adults with chronic insomnia. BACKGROUND: There is evidence to support the use of complementary interventions to improve sleep. They are rarely applied in Taiwanese elderly population. METHODS: Using a crossover controlled trial, 38 participants aged 50 to 75 years were randomly assigned to a music intervention/brisk walking sequence or a brisk walking/music intervention sequence. Each participant completed two intervention sessions (separated by 1 week). Each intervention lasted 30 min. An actigraph extended with electroencephalography (EEG) and questionnaires were used to assess the sleep quality. RESULTS: Both interventions exhibited beneficial effects on subjective sleep quality in adults with insomnia. Also listening to soothing music before bedtime significantly shortened the wake time after sleep onset measured by EEG, compared with brisk walking in the evening. CONCLUSIONS: The interventions applied in this study could be applied as the evidence-based nursing interventions for insomnia older adults.

Influence of work values and personality traits on intent to stay among nurses at various types of hospital in Taiwan.

AIM: In this study, the influence of work values and personality traits on the intent to stay at work was examined among nurses in Taiwan. BACKGROUND: No empirical studies in this area have been conducted in the nursing industry. METHODS: A cross-sectional predictive study was performed during 2012 with 1246 nurses recruited from three different types of hospital located in northeastern Taiwan. A structured questionnaire based on the 5-factor model was used. Multiple regression analyses were used to investigate the various factors associated with the intent to stay at work among nurses. RESULTS: The overall response rate was 85%. The nurses who had a high level of intent to stay at work were significantly more likely to be in senior roles; exhibited positive work values, conscientiousness, emotional stability; and worked at a non-religious hospital. CONCLUSION: Age, the role of work values, personality traits and type of hospital were crucial in enhancing the level of intent to stay at work. IMPLICATIONS FOR NURSING MANAGEMENT: The study findings provide evidence for managers to develop an optimal strategy for nurses with specific personality traits and highly positive work values, which can guide the recruitment and retention of nurses.

Targeting of the deubiquitinase USP9X attenuates B-cell acute lymphoblastic leukemia cell survival and overcomes glucocorticoid resistance.

Although previous studies attributed a pro-survival role to USP9X in human cancer, how USP9X affects B-cell acute lymphoblastic leukemia (B-ALL) remains unclear. Here, we found that USP9X is overexpressed in B-ALL cell lines and human patients. We investigated the role of USP9X in B-ALL and found that USP9X knockdown significantly reduced leukemic cell growth and increased spontaneous apoptosis, thereby improving survival in immunodeficient mice. These effects are partially mediated by the intrinsic apoptotic pathway, as we found that USP9X-knockdown leukemic cells displayed MCL1 down-regulation, with decreased BCL-2/BCL-XL levels and increased BAX levels. In addition, we demonstrated that USP9X inhibition negatively regulates mTORC1 activity toward its substrate S6K1. Clinically, USP9X inhibition sensitized glucocorticoid-resistant ALL cells to prednisolone; this observation reveals a potential avenue for improving the treatment of drug-resistant relapses. Collectively, our findings suggest that the combination of USP9X targeting and glucocorticoids treatment has attractive utility in B-ALL. This approach represents a potential strategy for promising combination therapies for lymphoid malignancies.

Snoring in a sitting position and neck circumference are predictors of sleep apnea in Chinese patients.

BACKGROUND: Snoring is a common symptom among the adult population, and it is the most common complaint in patients with obstructive sleep apnea (OSA) syndrome. Patients who snore in a sitting position while taking a nap or sleeping may have a narrower upper airway. The aim of this study was to evaluate if snoring in a sitting position is a predictor of OSA in patients. METHOD: We prospectively enrolled 166 SS+ (with a history of snoring in a sitting position) subjects and 139 SS- (who denied having a history of snoring in a sitting position) patients. All of the participants received questionnaires as well as a standard polysomnography thereafter. RESULT: Patients with self-reported snoring in a sitting position (with a tilt position greater than 70°, SS+ group) had a higher body mass index as well as greater neck, waist, and buttock circumference and scored higher on the Epworth Sleepiness Scale. During the polysomnographic study, the SS+ group had a higher percentage of N1 sleep and lower percentage of N2 sleep. In addition, the SS+ group had a higher apnea-hypopnea index (AHI) as well as higher arousal index and oxygen desaturation index. The sensitivity and specificity of the SS+ group for OSA (defined as AHI ≥ 5) were 0.59 and 0.73, respectively, with a positive predictive value of 0.93. The likelihood ratio was 2.2. On the other hand, the sensitivity and specificity of the SS+ group for moderate to severe OSA (defined as AHI ≥ 15) were 0.82 and 0.48, respectively. Both SS+ and greater neck circumference have a high likelihood ratio for diagnosing OSA. CONCLUSION: In the present study, the symptoms of self-reported snoring in a sitting position and greater neck circumference can be useful clinical predictors of OSA in Chinese patients.

Risk factors for postoperative recurrence of cesarean scar endometriosis.

BACKGROUND: The increasing global prevalence of cesarean scar endometriosis necessitates a thorough understanding of the risk factors for postoperative recurrence, as this is crucial for developing preventive strategies and informed decision-making. OBJECTIVE: To obtain insight into the clinical risk factors for postoperative recurrence of cesarean scar endometriosis following open lesion resection. STUDY DESIGN: The cohort for this study comprised 272 women, including 26 patients with postoperative recurrence and 246 without recurrence. Various parameters, including baseline characteristics, preoperative, intraoperative, and postoperative conditions, and follow-up information, were analyzed. A comparison of these parameters was made between patients with and without postoperative recurrence. Time-to-recurrence analyses were conducted using Cox's univariate and multivariate proportional hazard analyses, the Kaplan-Meier method, and the log-rank test. RESULTS: The results revealed significant differences between patients with and without postoperative recurrence in terms of visual analog scale for abdominal pain (P=.008), method of surgery (P<.001), and incision length (P=.002). The Cox proportional hazard model identified the visual analog scale for abdominal pain ≥4 as a significant risk factor for postoperative recurrence (hazard ratio, 3.72 [95% confidence interval, 1.65-8.43]; P=.002). In addition, patients who received removal of scar, excision of mass, and exploration underneath the scar (named as integrated excision) had a lower risk of recurrence than those who received local excision of mass (hazard ratio, 0.14 [95% confidence interval, 0.04-0.48]; P=.002). Furthermore, older patients (aged ≥35 years) were found to have a lower risk of postoperative recurrence than those <35 years (hazard ratio, 0.35 [95% confidence interval, 0.12-1.04]; P=.058). In addition, the depth of involvement was identified as a meaningful factor in postoperative recurrence for patients with local excision of mass, as determined by the log-rank test (P=.018). CONCLUSION: The study highlights that the visual analog scale for abdominal pain ≥4 is a risk factor for the recurrence of cesarean scar endometriosis after open lesion resection. Furthermore, the surgical method of integrated excision was identified as a protective factor.

A path analysis investigation into menopausal osteoporosis, sarcopenia risk, and their impact on sleep quality, depressive symptoms and quality of life.

PURPOSE: The objective was to investigate the relationships among disease characteristics, sarcopenia risk, bone function, sleep quality, depressive symptoms, and health-related quality of life in menopausal women. Additionally, we also examined the potential mediating role of coping in the relationship between these factors and health outcomes for individuals with osteoporosis. METHODS: In a cross-sectional approach, 201 participants were referred by a physician from the Family Medicine Department during their outpatient visits at a general hospital in Southern Taiwan. Data collection involved structured one-on-one interviews, and the analysis included descriptive and inferential statistics, along with a structural equation modeling. RESULTS: The participants' bone function was strongly positively related to coping, physical and mental quality of life (QOL), and negatively related to sleep quality and depressive symptoms. The duration of osteoporosis was positively related to pain, sarcopenia risk, sleep quality, but negatively related to bone function, physical and mental QOL. This structural framework explains 36% of the variance in depressive symptoms, 25% in sleep disturbances, 54% in mental QOL, and 72% in physical QOL. The best-fit structural equation modeling showed that physical function, exercise, sarcopenia, pain, and coping were significant predictors of depressive symptoms, with coping acting as a mediator in these relationships. CONCLUSION: Individuals who employed more active coping strategies exhibited fewer depressive symptoms, better sleep quality, and superior physical and mental QOL. Further, individuals with osteoporosis had lower pain levels, less sarcopenia risk, and higher engaged in exercise presentation improved physical and mental QOL. Future longitudinal research holds the promise of providing deeper insights into these complex relationships.

The proliferation of beneficial bacteria influences the soil C, N, and P cycling in the soybean-maize intercropping system.

Soybean-maize intercropping system can improve the utilization rate of farmland and the sustainability of crop production systems. However, there is a significant gap in understanding the interaction mechanisms between soil carbon (C), nitrogen (N), and phosphorus (P) cycling functional genes, rhizosphere microorganisms, and nutrient availability. To reveal the key microorganisms associated with soil nutrient utilization and C, N, and P cycling function in the soybean-maize intercropping system, we investigated the changes in soil properties, microbial community structure, and abundance of functional genes for C, N, and P cycling under soybean-maize intercropping and monocropping at different fertility stages in a pot experiment. We found that there was no significant difference in the rhizosphere microbial community between soybean-maize intercropping and monocropping at the seeding stage. As the reproductive period progressed, differences in microbial community structure between intercropping and monocropping gradually became significant, manifesting the advantages of intercropping. During the intercropping process of soybean and maize, the relative abundance of beneficial bacteria in soil rhizosphere significantly increased, particularly Streptomycetaceae and Pseudomonadaceae. Moreover, the abundances of C, N, and P cycling functional genes, such as abfA, mnp, rbcL, pmoA (C cycling), nifH, nirS-3, nosZ-2, amoB (N cycling), phoD, and ppx (P cycling), also increased significantly. Redundancy analysis and correlation analysis showed that Streptomycetaceae and Pseudomonadaceae were significantly correlated with soil properties and C, N, and P cycling functional genes. In brief, soybean and maize intercropping can change the structure of microbial community and promote the proliferation of beneficial bacteria in the soil rhizosphere. The accumulation of these beneficial bacteria increased the abundance of C, N, and P cycling functional genes in soil and enhanced the ability of plants to fully utilize environmental nutrients and promoted growth.

A randomized controlled trial of the effects of listening to non-commercial music on quality of nocturnal sleep and relaxation indices in patients in medical intensive care unit.

AIM: The purpose was to examine the effects of non-commercial music on quality of sleep and relaxation indices, including heart rate, mean arterial pressure, and respiratory rate in patients in intensive care units. BACKGROUND: There is currently insufficient scientific knowledge for the effects of music on quality of sleep in critically ill patients. DESIGN: A randomized controlled trial. METHODS: Between January-December 2010, 28 patients aged 39-78 years were randomly assigned to music and control groups. Participants in the music groups listened to non-commercial music for 45 minutes at nocturnal sleep time. In the control group, participants slept with no music. Participants were assessed using vital signs monitors, standardized questionnaire, and polysomnography. Polysomnography sleep was recorded for the first 2 hours of the nocturnal sleep. General estimating equation was applied to analyse data. FINDINGS: Participants in the music group had shorter stage N2 sleep and longer stage N3 sleep in the first 2 hours of the nocturnal sleep and improved self-reported sleep quality, compared with those in the control group. The music group patients also had significantly lower heart rates than those in the control group. The intensive care units patients experienced fragmented sleep with a high frequency of awakenings and severe reduction in random eye movement sleep during the first 2 hours of the nocturnal sleep. CONCLUSION: The findings provided evidence for nurses to use soothing music as a research-based nursing intervention for intensive care unit patients' sleep improvement.

A nationwide survey of nurses' attitudes toward music therapy and their need for education in its application.

BACKGROUND: Music therapy is increasingly used to help heal patients. However, there is a significant gap in the literature about nurses' attitudes toward and need for education in music therapy for nursing practice. This cross-sectional study was conducted to describe nurses' attitudes toward music therapy and determine their need for education in music therapy. METHODS: Participants included 1,197 nurses who were recruited from hospitals in different regions of Taiwan. RESULTS: Participants expressed positive attitudes toward music therapy. Most participants were willing to learn about music therapy. "Skill in using musical instruments" was the most frequently identified educational need. Further study of the discrepancy between the attitudes toward "performing music therapy" and "learning music therapy" is needed to clarify why nurses expected that they would receive no support for attending music therapy education. CONCLUSION: Given participants' attitudes toward music therapy and their motivation for learning, nursing administrators and educators may consider developing policies to further the advancement of music therapy in educational programs and practice.

Nurses' perspectives on the application of humanistic anatomical knowledge in clinical practice.

Knowledge of human anatomy is vital for nurses. Medical educators use a variety of educational pedagogies, including the use of cadavers, to cultivate nursing students into competent and professional care providers and to help them gain authentic experience and knowledge before entering the workplace. Studies have provided numerous examples of students with positive learning experiences in human-centric (humanistic) anatomy courses; however, whether these positive experiences translate into effective clinical practice remains largely unknown. This study explored nurses' perspectives on the effects of a humanistic anatomy program on their nursing practice. Focus groups with semi-structured interview guidelines were conducted to collect data. Twenty-one nurses working in hospitals in Taiwan participated and divided themselves into four groups on the basis of willingness to participate and availability. The interviews were recorded using smartphones, and the recordings were transcribed using a computer. The transcriptions were then checked word by word artificially and analyzed by hand. Three main themes emerged during the analysis: adapting to the professional journey, managing time when providing humanistic care, and cultivating professionalism. The results demonstrate educators' expectations that humanistic anatomy education for nursing students expands students' professional knowledge and helps them develop humanistic competencies as professional nurses.

Predictors of success in the registered nurse licensure exam for nursing graduates whose education was affected by the COVID-19 pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health-care education. However, the relationship between changes in nursing internships in Taiwan during the COVID-19 pandemic and outcome in the national registered nurse (RN) licensure exam for new nursing graduates is underexplored. The study was to explore the predictors of first-attempt success in the RN licensure exam in 2022. A retrospective review of secondary data was employed in this study. Adjusted binary logistic regression was used to analyze data. A convenience sample of 78 new graduates attempted the exam. Of these graduates, 87.2% passed the RN licensure exam. Age was the main predictor of exam success, followed by grand mean academic score and total alternative (nontraditional in-person) internship hours. Compared with those who failed the exam, the graduates who passed the exam were significantly more likely to be younger, have better academic performance, and have engaged in more alternative internship hours. Nursing faculties should consider implementing supportive strategies early for students who are underperforming or those who are older than their classmates on average to help them pass the RN exam on the first attempt. The optimal duration and long-term consequences of alternative nursing internships must be analyzed in further detail.