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Purpose@#Ear reconstruction is one of the most difficult areas in the field of reconstructive surgery. Due to limitations of the current practice, a novel method of auricular reconstruction is needed. Major advancements in three-dimensional (3D) printing technique have rendered the process of ear reconstruction more favorable. Herein, we present our experience in designing and clinically using 3D implants in both 1st and 2nd stage ear reconstruction surgery. @*Materials and Methods@#After obtaining 3D CT data from each patient, a 3D geometric ear model was created using mirroring and segmentation processes. The 3D-printed implant design resembles but does not exactly match the normal ear shape, and can be inserted in harmony with the currently used surgical technique. The 2nd stage implant was designed to minimize dead space and support the posterior ear helix. The 3D implants were finally fabricated with a 3D printing system and used in ear reconstruction surgery in our institute. @*Results@#The 3D implants were manufactured for application to the currently used two-stage technique while maintaining the shape of the patient’s normal ear. The implants were successfully used for ear reconstruction surgery in microtia patients. A few months later, the 2nd stage implant was used in the 2nd stage operation. @*Conclusion@#The authors were able to design, fabricate, and apply patient-specific 3D-printed ear implants for 1st and 2nd stage ear reconstruction surgeries. This design, combined with 3D bioprinting technique, may be a future alternative for ear reconstruction.
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Background@#The guidelines of coronavirus disease 2019 (COVID-19) vaccination in patients with rheumatoid arthritis (RA) have been continuously updated, with extensive discussion on the effectiveness of the COVID-19 booster vaccines and antibody generation associated with the different types of vaccine. We investigated the effects of the third dose of the mRNA vaccine on antibody titer and the factors associated with antibody production in patients with RA who had previously received two doses of the ChAdOx1-S nCoV-19 vaccine. @*Methods@#Between October 14, 2021 and June 17, 2022, two patient groups diagnosed with RA were recruited prospectively: one with two doses of ChAdOx1-S nCoV-19 and the second group with the additional third mRNA vaccine. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers were determined through semiquantitative anti-SARS-CoV-2 spike (S) electrochemiluminescence immunoassay. Antibody titers were compared in both groups considering clinical features and medications. Multivariate logistic regression was performed to identify the factors associated with antibody production. Also, we followed up the antibody titers of whom completed the 3rd mRNA vaccination. @*Results@#Among 261 patients, all patients were over 60 years old except for 7 patients and the average age was 65 years; 153 had completed two doses of ChAdOx1-S nCoV-19, while 108 patients had also received the third mRNA vaccine. The positive rates of anti-SARS-CoV-2 anti-S1/receptor binding domain-specific antibody (titer > 0.8 U/mL) were 97% (149/153) and 99% (107/108) respectively. However, positive rates for high antibody titer (> 250 U/ mL) were found in only 31% (47/153) of group 1 but 94% (102/108) of group 2. Multivariate analysis revealed that corticosteroid use (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.16–0.75), older age (OR, 0.91; 95% CI, 0.860–0.98), and male sex (OR, 0.23; 95% CI, 0.07–0.74) were associated with a lower rate of high antibody titer acquisition after two doses of ChAdOx1-S nCoV-19. Waning of antibody titers was observed in only two of 46 patients who followed up twice after the third mRNA vaccine inoculation. @*Conclusion@#Our findings suggest that the third dose of the mRNA vaccine could be beneficial in RA patients with risk factors including older age, male sex, and corticosteroid use after two doses of ChAdOx1-S nCoV-19.
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Purpose@#The purpose of this study was to evaluate the nutritional quality of complementary baby food products sold in Korea according to the baby food stages and food composition. @*Methods@#A total of 1,587 complementary food products sold online and offline between March and December 2021 were investigated. They ranged from liquid meals to solid rice for babies aged 5 to 36 months. @*Results@#The number of intakes per packaged volume was 2.8 in Stage 1, 1.9 in Stage 2, 1.4 in Stage 3, and 1.1 in Stage 4 (p < 0.0001). The dietary variety scores (DVS) of the complementary baby food products were 3.4 in Stage 1, 5.5 in Stage 2, 7.1 in Stage 3, and 9.7 in Stage 4 (p < 0.0001) and showed a significant increase in the later stages. The Korean dietary diversity score (KDDS) significantly increased from 2.3 in Stage 1, to 2.8 in Stage 2, 3.0 in Stage 3, and 3.4 in Stage 4 (p < 0.0001). The higher the baby food stage, the higher the proportion of grains/meat/vegetable ingredients. The ratio of protein intake to Adequate Intake (AI) or Recommended Nutrition Intake (RNI) was higher in products with a KDDS of 3 points or more, or in products with 2 points or fewer in Stages 1 and 2 (p < 0.0001, respectively). The ratio of protein intake to RNI increased as the KDDS score increased in Stages 3 and 4 (p < 0.0001, respectively). For all stages of baby foods, the ratio of protein intake to AI or RNI was high in products that included the meat group (beans, nuts, meat, eggs, fish, and shellfish) (p < 0.0001, respectively). @*Conclusion@#Continuous research and nutritional evaluation are required for establishing nutrient content standards for commercially available baby foods, considering breast milk intake.
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Purpose@#This study aimed to construct and validate a model of the quality of working life (QWL) among cancer survivors returning to work. @*Methods@#A cross-sectional study was developed. Participants included 204 cancer survivors in the extended cancer survivor stage, 6 months after returning to work, who were treated at two tertiary hospital cancer centers. The data were analyzed with SPSS 22.0 and AMOS 20.0 for confirmatory factor analysis to assess the hypothesis fit and verify the hypothesis. @*Results@#Factors affecting cancer survivors’ quality of working liferesulted in cancer stigma and social support (explanatory power was 43.1%) and the model showed acceptable goodness of fit. In the final model, cancer stigma had a significant direct effect on social support and indirect effect on organizational health, employee health, and QWL. Additionally, social support had significant direct effect on organizational health, employee health and QWL. @*Conclusion@#Based on the results of this study, there is a need to develop strategies and effective intervention programs that can increase the support of supervisors and colleagues for improving overall quality of work life. Furthermore, the development of policies and intervention programs to reduce cancer stigma for the purpose of transforming perceptions through education and public relations which are indirect factors that affect the quality of work life, can contribute to improving the quality of work life for cancer survivors.
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Purpose@#This study aimed to construct and validate a model of the quality of working life (QWL) among cancer survivors returning to work. @*Methods@#A cross-sectional study was developed. Participants included 204 cancer survivors in the extended cancer survivor stage, 6 months after returning to work, who were treated at two tertiary hospital cancer centers. The data were analyzed with SPSS 22.0 and AMOS 20.0 for confirmatory factor analysis to assess the hypothesis fit and verify the hypothesis. @*Results@#Factors affecting cancer survivors’ quality of working liferesulted in cancer stigma and social support (explanatory power was 43.1%) and the model showed acceptable goodness of fit. In the final model, cancer stigma had a significant direct effect on social support and indirect effect on organizational health, employee health, and QWL. Additionally, social support had significant direct effect on organizational health, employee health and QWL. @*Conclusion@#Based on the results of this study, there is a need to develop strategies and effective intervention programs that can increase the support of supervisors and colleagues for improving overall quality of work life. Furthermore, the development of policies and intervention programs to reduce cancer stigma for the purpose of transforming perceptions through education and public relations which are indirect factors that affect the quality of work life, can contribute to improving the quality of work life for cancer survivors.
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Purpose@#This study was conducted to develop and examine the effects of a nursing education program using virtual reality to enhance clinical decision-making ability in respiratory disease nursing care by assessing students’ confidence in performance, clinical decision-making ability, practice flow, class evaluations, and simulation design evaluations. @*Methods@#This study was developed based on the Jeffries simulation model and 5E learning cycle model, blending a virtual reality simulation and high-fidelity simulation. The participants were 41 third-year nursing students with no virtual reality and simulation education experience. The experimental group (n=21) received the virtual reality program, while the control group (n=20) received traditional simulation education. Data were collected from March 8 to May 28, 2021 and analyzed using SPSS version 27 for Windows. @*Results@#Statistically significant differences were found between the experimental group and the control group post-intervention in confidence in performance (F=4.88, p=.33) and clinical decision-making ability (F=18.68, p＜.001). The experimental group showed significant increases in practice flow (t=2.34, p=.024) and class evaluations (t=2.99, p=.005) compared to the control group. @*Conclusion@#Nursing education programs using virtual reality to enhance clinical decision-making ability in respiratory disease nursing care can be an effective educational strategy in the clinical context.
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PURPOSE@#To evaluate the optimal measurement location, cut-off value, and diagnostic performance of S-Shearwave in differential diagnosis of breast masses seen on ultrasonography (US).@*MATERIALS AND METHODS@#During the study period, 225 breast masses in 197 women were included. S-Shearwave measurements were made by applying a square region-of-interest automatically generated by the US machine. Shearwave elasticity was measured three times at four different locations of the mass, and the highest shearwave elasticity was used for calculating the optimal cut-off value. Diagnostic performance was evaluated by using the area under the receiving operator characteristic curve (AUC).@*RESULTS@#Of the 225 breast masses, 156 (69.3%) were benign and 69 (30.7%) were malignant. Mean S-Shearwave values were significantly higher for malignant masses (108.0 ± 70.0 kPa vs. 43.4 ± 38.3 kPa; p < 0.001). No significant differences were seen among AUC values at different measurement locations. With a cut-off value of 41.9 kPa, S-Shearwave showed 85.7% sensitivity, 63.9% specificity, 70.7% accuracy, and positive and negative predictive values of 51.7% and 90.8%, respectively. The AUCs for US and S-Shearwave did not show significant differences (p = 0.179).@*CONCLUSION@#S-Shearwave shows comparable diagnostic performance to that of grayscale US that can be applied for differential diagnosis of breast masses seen on US.
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Purpose@#Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy. @*Methods@#Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed. @*Results@#Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality. @*Conclusion@#Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.
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PURPOSE: The purpose of this study is to identify the nurses' perceptions of the anticipated problems (including concern, anxiety etc.) of pregnant women that are diagnosed or treated with cancer using the Korean version of the Cancer and Pregnancy Questionnaire (CPQ) tool. METHODS: Data were collected from 475 clinical nurses working in hospitals using a questionnaire that included 40 items (consisting of 5 subscales) of the Korean version of the CPQ and 2 items of nursing confidence. The collected data were analyzed using SPSS 25.0. The characteristics of the nurses were calculated as a percentage and mean with standard deviations. Pearson's correlation was used to analyze the correlation between the sub-domains of the Korean CPQ tool and the characteristics of the nurse. RESULTS: Nurses were most concerned about child health, cancer, and treatment of the women receiving cancer treatment during pregnancy; cancer treatment may be harmful to unborn child (6.20±1.00), will have a physical abnormality (6.08±1.06), have brain damaged or mental disability (6.07±1.04) and the extent of the physical exhaustion (6.12±0.88). CONCLUSION: Nurses need a more accurate understanding of the anxiety and stress of women about birth results and outcomes due to cancer treatment during pregnancy. They should be prepared to develop confidence in treatment for these patients.
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Child , Female , Humans , Pregnancy , Anxiety , Brain , Child Health , Nursing , Parturition , Patient Care , Pregnant WomenABSTRACT
PURPOSE: This study was conducted to identify subjective attitudes towards terminal patients in nursing students who had clinical practice. The types of subjective attitude were classified by applying Q methodology. According to those types, basic reference data for the development of educational programs were provided.METHODS: Thirty-four final Q samples were selected, and Q classification with a nine-point scale was performed with P samples of 43 nursing students. A key factor analysis was conducted with the collected data using the PC QUANAL program.RESULTS: Nursing students' attitudes towards terminal patients were grouped into three types. The total variable was 49.96%. Students with Type 1 (“wish for life-sustaining medical treatment”) thought that terminal patients accurately understood their medical condition and wanted to prolong their lives. Others with Type 2 (“need for service and support”) believed that a multidisciplinary nursing system needs to be established to help terminal patients prepare for death. Students with Type 3 (‘awareness and acceptance of death’) thought that terminal patients wanted to die with dignity at a hospice unit.CONCLUSION: This study analyzed various types of attitude towards terminal patients, as perceived by nursing students with clinical training experience. Development of educational programs for each attitude type analyzed in this study could contribute to systematic training programs for nursing students caring for terminal patients.
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Humans , Classification , Education , Hospices , Nursing , Students, Nursing , Terminally IllABSTRACT
BACKGROUND/AIMS: Programmed death receptor 1 (PD-1) is a promising new target for treatment of patients with hepatocellular carcinoma (HCC). A high expression level of programmed death-ligand 1 (PD-L1) is a possible prognostic indicator for poor outcome in other malignancies. Here, we investigated the clinical significance of PD-1 and PD-L1 in patients with HCC. METHODS: We enrolled patients with HCC who underwent surgical resection at Severance Hospital between 2012 and 2017 and investigated the levels of PD-L1 in HCC tissues (tPD-L1) and PD-L1/PD-1 in serum (sPD-L1/sPD-1). We also aimed to determine whether expression levels correlated with clinical and histological features. RESULTS: A total of 72 patient samples were analyzed. The median sPD-L1 and sPD-1 levels were 25.72 and 341.44 pg/mL, respectively. A positive correlation was detected between tPD-L1 and sPD-1 levels (R²=0.426, P50% reduction in sPD-1 levels was observed immediately after nivolumab administration. However, sPD-1 level was not associated directly with prognosis in patients with advanced HCC. CONCLUSIONS: The results demonstrated that PD-L1 and PD-1 levels changed according to the immunotherapy. However, no significant association with clinical outcome in patients with HCC was detected.
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Humans , Carcinoma, Hepatocellular , Follow-Up Studies , Immunotherapy , Mortality , PrognosisABSTRACT
BACKGROUND: The growth of Korean adolescents' average height has slowed over the past 10 years. The objective of this study was to investigate the association between height and mental health in Korean male adolescents.METHODS: This study used data from the 2015 Korea Youth Risk Behavior Web-based Survey (34,152 male school students). The male adolescents were divided into the below-average height and above-average height groups according to age. The association between height and mental health was analyzed by multivariate logistic regression.RESULTS: The above-average height group had significantly higher subjective health (P=0.003) and significantly lower depression than the belowaverage height group (P=0.031). In multivariate logistic regression, the odds ratio of subjective health wass 1.13 (P=0.043), but no significant difference in subjective happiness, depression, stress and suicidal ideation (P>0.05) at both group.CONCLUSION: It was confirmed that height is associated with subjective health in Korean male adolescents.
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Adolescent , Humans , Male , Depression , Diagnostic Self Evaluation , Happiness , Korea , Logistic Models , Mental Health , Odds Ratio , Risk-Taking , Suicidal IdeationABSTRACT
BACKGROUND: Mesenchymal stem cells (MSCs) can be used for a wide range of therapeutic applications because of not only their differentiation potential but also their ability to secrete bioactive factors. Recently, several studies have suggested the use of human embryonic stem cell-derived MSCs (hE-MSCs) as an alternative for regenerative cellular therapy due to mass production of MSCs from a single donor. METHODS: We generated hE-MSCs from embryonic stem cell lines, SNUhES3, and analyzed immune properties of these cells. Also, we evaluated the in-vivo therapeutic potential of hE-MSCs in immune-mediated inflammatory skin disease. RESULTS: The cell showed the suppression of immunity associated with allogenic peripheral blood mononuclear cells in mixed lymphocyte response assay. We also detected that cytokines and growth factor related to the immune response were secreted from these cells. To assessed the in-vivo therapeutic potential of hE-MSCs in immune-mediated inflammatory skin disease, we used imiquimod (IMQ)-induced skin psoriasis mouse model. The score of clinical skin was significantly reduced in the hE-MSCs treated group compared with control IMQ group. In histological analysis, the IMQ-induced epidermal thickness was significantly decreased by hE-MSCs treatment. It was correlated with splenomegaly induced by IMQ which was also improved in the hE-MSCs. Moreover, IMQ-induced inflammatory cytokines; Th1 cytokines (TNF-α, IFN-α, IFN-γ,and IL-27) and Th17 cytokines (IL-17A and IL-23), in the serum and skin showed marked inhibition by hEMSCs. CONCLUSION: These results suggested that hE-MSCs have a potency of immune modulation in psoriasis, which might be the key factor for the improved psoriasis.
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Animals , Humans , Mice , Cytokines , Embryonic Stem Cells , Lymphocytes , Mesenchymal Stem Cells , Psoriasis , Skin Diseases , Skin , Splenomegaly , Tissue DonorsABSTRACT
OBJECTIVE: To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU. MATERIALS AND METHODS: This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated. RESULTS: The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose (5.73 ± 4.04 vs. 8.43 ± 4.38 mSv) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ≥ 3), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group. CONCLUSION: The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.
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Humans , Commerce , Contrast Media , Iodine , Noise , Prospective Studies , Radiation Exposure , Signal-To-Noise Ratio , Urinary Tract , UrographyABSTRACT
Endometriosis is one of the most common diseases in reproductive ages, and it affects patients' quality of life and fertility. However, few Korean guidelines are available for the evaluation and management of endometriosis. Korean Society of Endometriosis reviewed various literatures and trials, and to provide seventy-one evidence-based recommendations. This review presents guidelines for the diagnosis and management of endometriosis with emphasis on: it's role in infertility, treatment of recurrence, asymptomatic women, endometriosis in adolescents and menopausal women, and possible association of endometriosis with cancer.
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Adolescent , Female , Humans , Diagnosis , Dysmenorrhea , Endometriosis , Fertility , Infertility , Pelvic Pain , Quality of Life , RecurrenceABSTRACT
PURPOSE: Anger management is a very important issue for nursing education. However, there is a lack of research identifying related factors. This study examined the mediating effects of social support and a grateful disposition on the relationship between life stress and anger in nursing students. METHODS: The participants were 172 nursing students recruited from two universities in cities in South Korea. Baron and Kenny's regression method and the Sobel test were used to analyze the mediating effects of social support and a grateful disposition on the association between life stress and anger. RESULTS: There were significant correlations between life stress, social support, a grateful disposition, and anger. In addition, social support and a grateful disposition exerted full mediating effects on the relationship between life stress and anger. CONCLUSION: Based on this study's results, enhancing social support and grateful disposition could help nursing students who experience anger resulting from life stress to manage their anger effectively. This finding suggests that, as specific strategies for anger management, nursing educators should encourage nursing students to use sources of social support and to engage in various gratitude activities.
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Humans , Anger Management Therapy , Anger , Education, Nursing , Korea , Methods , Negotiating , Nursing , Protective Factors , Stress, Psychological , Students, NursingABSTRACT
Myoblast fusion depends on mitochondrial integrity and intracellular Ca²⁺ signaling regulated by various ion channels. In this study, we investigated the ionic currents associated with [Ca²⁺]i regulation in normal and mitochondrial DNA-depleted (ρ0) L6 myoblasts. The ρ0 myoblasts showed impaired myotube formation. The inwardly rectifying K⁺ current (I(Kir)) was largely decreased with reduced expression of KIR2.1, whereas the voltage-operated Ca²⁺ channel and Ca²⁺-activated K⁺ channel currents were intact. Sustained inhibition of mitochondrial electron transport by antimycin A treatment (24 h) also decreased the I(Kir). The ρ0 myoblasts showed depolarized resting membrane potential and higher basal [Ca²⁺]ᵢ. Our results demonstrated the specific downregulation of I(Kir) by dysfunctional mitochondria. The resultant depolarization and altered Ca²⁺ signaling might be associated with impaired myoblast fusion in ρ0 myoblasts.
Subject(s)
Antimycin A , Down-Regulation , Electron Transport , Ion Channels , Membrane Potentials , Mitochondria , Muscle Development , Muscle Fibers, Skeletal , Myoblasts , Oxidative PhosphorylationABSTRACT
PURPOSE: The purpose of this study was to identify the relationships and the levels of emotional Intelligence, ego-resilience and nursing performance and to investigate the mediating effects of ego-resilience in the relationship emotional Intelligence with nursing performance among clinical nurses.METHODS: The study design was a cross-sectional survey. The study participants were a total of 142 clinical nurses who were registered in three general hospitals. The data were analyzed by frequency, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression analysis using SPSS 21.0 software and Sobel's test was conducted to evaluate availability of the mediating effects of ego-resilience.RESULTS: The study results had shown that there were significant co-relationships of the emotional Intelligence, ego-resilience and nursing performance and the mediating effects of ego-resilience in the relationship emotional Intelligence with nursing performance.CONCLUSION: Emotional intelligence in enhancing nursing performance, was an element to enhance hospital performance by managing self-emotion in relationships of patients and clinical staffs. In addition, ego-resilience as a mediating variable in the relationship emotional Intelligence with nursing performance, should be considered to develop each nursing department programs and strategy for improving nursing performance through enhancing emotional intelligence.
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Humans , Cross-Sectional Studies , Emotional Intelligence , Hospitals, General , Negotiating , NursingABSTRACT
PURPOSE: The purpose of this study was to identify factors influencing the quality of working life of cancer survivors (QWL-CS) after return to the workplace. METHODS: Data were collected from 154 cancer survivors from May 16 to June 23, 2018. Participants were selected as candidates from two different hospitals in the metropolitan area and snowball sampling was used in parallel. The data were analyzed by SPSS 21.0 using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and stepwise multiple linear regression. RESULTS: Mean score of QWL-CS was 4.39±0.59. QWL-CS was negatively correlated with fatigue, and job stress: however, it was positively correlated with workplace spirituality. The factor that had the greatest influence on the QWL-CS was job stress (β=−.36, p < .001), followed by fatigue (β=−.35, p < .001), workplace spirituality (β=.35, p < .001), number of currently cancer treatment (β=−.15, p=.009), and number of children (β=.12, p=.031). The explanatory power of models was 54%. CONCLUSION: Effective and practical intervention programs for increasing the quality of working life are required to be provided to cancer survivors after return to the workplace in accordance with job stress, fatigue, workplace spirituality, and general characteristics of cancer survivors such as number of currently cancer treatments and number of children.