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By multivariate binary logistic regression, failure of HFNC is associated with lower ROX index at 12 h after HFNC. ROX index at 12 h serves as a valuable tool to monitor the responsiveness to HFNC treatment. Close monitoring is required to identify patient failing using HFNC. ROX index at 12 h serves as a valuable tool to monitor the responsiveness to HFNC treatment. Close monitoring is required to identify patient failing using HFNC. This study aimed to examine the effects of a training program combining formal cytological curriculum and