Purpose: This study aimed to evaluate the effects of a narrative therapy training program using MetaverseZEP on attitudes toward severe mental illness, counselor self-efficacy, and emotional exhaustion in psychiatric mental health nurses. Methods: A non-equivalent control group pretest-posttest design was used. Participants included 47 psychiatric mental health nurses. The program consisted of 14 sessions, each lasting 60 minutes, conducted over four weeks (three to four sessions per week). Its effectiveness was assessed using pre-test, post-test, and follow-up test with the Attitudes to Severe Mental Illness Scale, Counselor Self-Efficacy Scale, and Emotional Exhaustion Scale. Data were analyzed using x2 tests, Fisher’s exact probability test, t-tests, and repeated measures ANOVA in IBM SPSS Statistics 25. Results: Participants in the experimental group showed significant improvements in attitudes toward severe mental illness (F=3.29, p=.047) and counseling self-efficacy (F=7.14, p=.002) compared to the control group. Conclusion The narrative therapy training program using MetaverseZEP effectively enhances counselor self-efficacy and attitudes toward severe mental illness in psychiatric mental health nurses. These findings suggest its potential as a valuable nurse training program.

Purpose: Sarcopenia is a poor prognostic factor in non–small cell lung cancer (NSCLC). However, its prognostic significance in patients with NSCLC receiving immune checkpoint inhibitors (ICIs) and its relationship with lymphopenia remain unclear. We aimed to investigate the prognostic role of sarcopenia and its effect on lymphocyte recovery in patients with stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) followed by ICI. Materials and Methods: We retrospectively evaluated 151 patients with stage III NSCLC who received definitive CCRT followed by maintenance ICI between January 2016 and June 2022. Sarcopenia was evaluated by measuring the skeletal muscle area at the L3 vertebra level using computed tomography scans. Lymphocyte level changes were assessed based on measurements taken before and during CCRT and at 1, 2, 3, 6, and 12 months post-CCRT completion. Results: Even after adjusting for baseline absolute lymphocyte count through propensity score-matching, patients with pre-radiotherapy (RT) sarcopenia (n=86) exhibited poor lymphocyte recovery and a significantly high incidence of grade ≥ 3 lymphopenia during CCRT. Pre-RT sarcopenia and grade ≥ 3 lymphopenia during CCRT emerged as prognostic factors for overall survival and progression-free survival, respectively. Concurrent chemotherapy dose adjustments, objective response after CCRT, and discontinuation of maintenance ICI were also analyzed as independent prognostic factors. Conclusion Our results demonstrated an association between pre-RT sarcopenia and poor survival, concurrent chemotherapy dose adjustments, and impaired lymphocyte recovery after definitive CCRT. Moreover, CCRT-induced lymphopenia not only contributed to poor prognosis but may have also impaired the therapeutic efficacy of subsequent maintenance ICI, ultimately worsening treatment outcomes.

Purpose: This study aimed to develop a graded prognostic assessment (GPA) model integrating genomic characteristics for elderly patients with glioblastoma (eGBM), and to compare the efficacy of different radiotherapy schedules. Materials and Methods: This multi-institutional retrospective study included patients aged ≥ 65 years who underwent surgical resection followed by radiotherapy with or without temozolomide (TMZ) for newly diagnosed eGBM. Based on the significant factors identified in the multivariate analysis for overall survival (OS), the molecular GPA for eGBM (eGBM-molGPA) was established. Results: A total of 334 and 239 patients who underwent conventionally fractionated radiotherapy (CFRT) and hypofractionated radiotherapy (HFRT) were included, respectively, with 86% of patients receiving TMZ-based chemoradiation. With a median follow-up of 17.4 months (range, 3.3 to 149.9 months), the median OS was 18.7 months for CFRT+TMZ group, 15.1 months for HFRT+TMZ group, and 10.4 months for radiotherapy alone group (CFRT+TMZ vs. HFRT+TMZ: hazard ratio [HR], 1.52; p < 0.001 and CFRT+TMZ vs. radiotherapy alone: HR, 2.52; p < 0.001). In a combined analysis with the NOA-08 and Nordic trials, CFRT+TMZ group exhibited the highest survival rates among all treatment groups. The eGBM-molGPA, which integrated four clinical and three molecular parameters, stratified patients into low-, intermediate-, and high-risk groups. CFRT+TMZ significantly improved OS compared to HFRT+TMZ or radiotherapy alone in the low-risk (p=0.023) and intermediate-risk groups (p < 0.001). However, in the high-risk group, there was no significant difference in OS between treatment options (p=0.770). Conclusion CFRT+TMZ may be more effective than HFRT+TMZ or radiotherapy alone for selected eGBM patients. The novel eGBM-molGPA model can guide treatment selection for this patient population.

Purpose: This study aimed to evaluate the effects of a narrative therapy training program using MetaverseZEP on attitudes toward severe mental illness, counselor self-efficacy, and emotional exhaustion in psychiatric mental health nurses. Methods: A non-equivalent control group pretest-posttest design was used. Participants included 47 psychiatric mental health nurses. The program consisted of 14 sessions, each lasting 60 minutes, conducted over four weeks (three to four sessions per week). Its effectiveness was assessed using pre-test, post-test, and follow-up test with the Attitudes to Severe Mental Illness Scale, Counselor Self-Efficacy Scale, and Emotional Exhaustion Scale. Data were analyzed using x2 tests, Fisher’s exact probability test, t-tests, and repeated measures ANOVA in IBM SPSS Statistics 25. Results: Participants in the experimental group showed significant improvements in attitudes toward severe mental illness (F=3.29, p=.047) and counseling self-efficacy (F=7.14, p=.002) compared to the control group. Conclusion The narrative therapy training program using MetaverseZEP effectively enhances counselor self-efficacy and attitudes toward severe mental illness in psychiatric mental health nurses. These findings suggest its potential as a valuable nurse training program.

Purpose: This study aimed to evaluate the effects of a narrative therapy training program using MetaverseZEP on attitudes toward severe mental illness, counselor self-efficacy, and emotional exhaustion in psychiatric mental health nurses. Methods: A non-equivalent control group pretest-posttest design was used. Participants included 47 psychiatric mental health nurses. The program consisted of 14 sessions, each lasting 60 minutes, conducted over four weeks (three to four sessions per week). Its effectiveness was assessed using pre-test, post-test, and follow-up test with the Attitudes to Severe Mental Illness Scale, Counselor Self-Efficacy Scale, and Emotional Exhaustion Scale. Data were analyzed using x2 tests, Fisher’s exact probability test, t-tests, and repeated measures ANOVA in IBM SPSS Statistics 25. Results: Participants in the experimental group showed significant improvements in attitudes toward severe mental illness (F=3.29, p=.047) and counseling self-efficacy (F=7.14, p=.002) compared to the control group. Conclusion The narrative therapy training program using MetaverseZEP effectively enhances counselor self-efficacy and attitudes toward severe mental illness in psychiatric mental health nurses. These findings suggest its potential as a valuable nurse training program.

Purpose: This study aimed to evaluate the effects of a narrative therapy training program using MetaverseZEP on attitudes toward severe mental illness, counselor self-efficacy, and emotional exhaustion in psychiatric mental health nurses. Methods: A non-equivalent control group pretest-posttest design was used. Participants included 47 psychiatric mental health nurses. The program consisted of 14 sessions, each lasting 60 minutes, conducted over four weeks (three to four sessions per week). Its effectiveness was assessed using pre-test, post-test, and follow-up test with the Attitudes to Severe Mental Illness Scale, Counselor Self-Efficacy Scale, and Emotional Exhaustion Scale. Data were analyzed using x2 tests, Fisher’s exact probability test, t-tests, and repeated measures ANOVA in IBM SPSS Statistics 25. Results: Participants in the experimental group showed significant improvements in attitudes toward severe mental illness (F=3.29, p=.047) and counseling self-efficacy (F=7.14, p=.002) compared to the control group. Conclusion The narrative therapy training program using MetaverseZEP effectively enhances counselor self-efficacy and attitudes toward severe mental illness in psychiatric mental health nurses. These findings suggest its potential as a valuable nurse training program.

Purpose: This study examined the mediating effects of psychological flexibility on the relationship between socially prescribed perfectionism, time pressure, and mental well-being among infection control nurses. Methods: Data were collected from 178 infection control nurses with at least a year's experience via online communities from March 9 to 18, 2024. Descriptive statistics, the independent t-test (Mann-Whitney test), one-way analysis of variance (Scheffé test), Pearson's correlation coefficients, and hierarchical multiple regression analysis were conducted using the IBM SPSS Statistics version 29.0. Results: Socially prescribed perfectionism (r=-.48, p<.001) and time pressure (r=-.20, p=.008) showed statistically significant negative correlations with mental well-being, while psychological flexibility exhibited a positive correlation (r=.69, p<.001). Furthermore, psychological flexibility fully mediated the relationships between socially prescribed perfectionism(bootstrapped lower of the confidence interval [LLCI]=-.36, bootstrapped upper of the confidence interval [ULCI]=-.19) and time pressure (bootstrapped LLCI=-.21, bootstrapped ULCI=-.06) with mental well-being. Conclusion The findings suggest that psychological flexibility can buffer the negative effects of socially prescribed perfectionism and time pressure on infection control nurses' mental well-being, following the end of the pandemic. Increasing psychological flexibility is essential for mitigating mental health challenges and preparing for future infectious disease outbreaks.

Purpose: Sarcopenia is a poor prognostic factor in non–small cell lung cancer (NSCLC). However, its prognostic significance in patients with NSCLC receiving immune checkpoint inhibitors (ICIs) and its relationship with lymphopenia remain unclear. We aimed to investigate the prognostic role of sarcopenia and its effect on lymphocyte recovery in patients with stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) followed by ICI. Materials and Methods: We retrospectively evaluated 151 patients with stage III NSCLC who received definitive CCRT followed by maintenance ICI between January 2016 and June 2022. Sarcopenia was evaluated by measuring the skeletal muscle area at the L3 vertebra level using computed tomography scans. Lymphocyte level changes were assessed based on measurements taken before and during CCRT and at 1, 2, 3, 6, and 12 months post-CCRT completion. Results: Even after adjusting for baseline absolute lymphocyte count through propensity score-matching, patients with pre-radiotherapy (RT) sarcopenia (n=86) exhibited poor lymphocyte recovery and a significantly high incidence of grade ≥ 3 lymphopenia during CCRT. Pre-RT sarcopenia and grade ≥ 3 lymphopenia during CCRT emerged as prognostic factors for overall survival and progression-free survival, respectively. Concurrent chemotherapy dose adjustments, objective response after CCRT, and discontinuation of maintenance ICI were also analyzed as independent prognostic factors. Conclusion Our results demonstrated an association between pre-RT sarcopenia and poor survival, concurrent chemotherapy dose adjustments, and impaired lymphocyte recovery after definitive CCRT. Moreover, CCRT-induced lymphopenia not only contributed to poor prognosis but may have also impaired the therapeutic efficacy of subsequent maintenance ICI, ultimately worsening treatment outcomes.

Purpose: This study aimed to develop a graded prognostic assessment (GPA) model integrating genomic characteristics for elderly patients with glioblastoma (eGBM), and to compare the efficacy of different radiotherapy schedules. Materials and Methods: This multi-institutional retrospective study included patients aged ≥ 65 years who underwent surgical resection followed by radiotherapy with or without temozolomide (TMZ) for newly diagnosed eGBM. Based on the significant factors identified in the multivariate analysis for overall survival (OS), the molecular GPA for eGBM (eGBM-molGPA) was established. Results: A total of 334 and 239 patients who underwent conventionally fractionated radiotherapy (CFRT) and hypofractionated radiotherapy (HFRT) were included, respectively, with 86% of patients receiving TMZ-based chemoradiation. With a median follow-up of 17.4 months (range, 3.3 to 149.9 months), the median OS was 18.7 months for CFRT+TMZ group, 15.1 months for HFRT+TMZ group, and 10.4 months for radiotherapy alone group (CFRT+TMZ vs. HFRT+TMZ: hazard ratio [HR], 1.52; p < 0.001 and CFRT+TMZ vs. radiotherapy alone: HR, 2.52; p < 0.001). In a combined analysis with the NOA-08 and Nordic trials, CFRT+TMZ group exhibited the highest survival rates among all treatment groups. The eGBM-molGPA, which integrated four clinical and three molecular parameters, stratified patients into low-, intermediate-, and high-risk groups. CFRT+TMZ significantly improved OS compared to HFRT+TMZ or radiotherapy alone in the low-risk (p=0.023) and intermediate-risk groups (p < 0.001). However, in the high-risk group, there was no significant difference in OS between treatment options (p=0.770). Conclusion CFRT+TMZ may be more effective than HFRT+TMZ or radiotherapy alone for selected eGBM patients. The novel eGBM-molGPA model can guide treatment selection for this patient population.

Purpose: This study examined the mediating effects of psychological flexibility on the relationship between socially prescribed perfectionism, time pressure, and mental well-being among infection control nurses. Methods: Data were collected from 178 infection control nurses with at least a year's experience via online communities from March 9 to 18, 2024. Descriptive statistics, the independent t-test (Mann-Whitney test), one-way analysis of variance (Scheffé test), Pearson's correlation coefficients, and hierarchical multiple regression analysis were conducted using the IBM SPSS Statistics version 29.0. Results: Socially prescribed perfectionism (r=-.48, p<.001) and time pressure (r=-.20, p=.008) showed statistically significant negative correlations with mental well-being, while psychological flexibility exhibited a positive correlation (r=.69, p<.001). Furthermore, psychological flexibility fully mediated the relationships between socially prescribed perfectionism(bootstrapped lower of the confidence interval [LLCI]=-.36, bootstrapped upper of the confidence interval [ULCI]=-.19) and time pressure (bootstrapped LLCI=-.21, bootstrapped ULCI=-.06) with mental well-being. Conclusion The findings suggest that psychological flexibility can buffer the negative effects of socially prescribed perfectionism and time pressure on infection control nurses' mental well-being, following the end of the pandemic. Increasing psychological flexibility is essential for mitigating mental health challenges and preparing for future infectious disease outbreaks.