Background: This study aimed to compare the effects of applying a vibrating foam roller before resistance exercise versus after resistance exercise on changes in serum muscle damage markers, muscle stiffness, and range of motion. This study also aimed to provide foundational data for optimizing the timing of vibrating foam roller application to enhance recovery after resistance exercise in practical settings. Methods: Twelve healthy adult males were recruited as participants. Each participant was subjected to three interventions in a random order with a washout period of at least 5 days: vibration foam rolling before resistance exercise, vibration foam rolling after resistance exercise, and resistance exercise without vibration foam rolling. Blood creatine kinase, knee flexion range of motion, and muscle stiffness were measured before, immediately after, 24 hours after, and 48 hours after exercise and foam rolling protocols. Results: Creatine kinase levels in vibration foam rolling after resistance exercise were significantly lower than those in vibration foam rolling before resistance exercise at 24 and 48 hours post-exercise. Muscle stiffness was significantly lower immediately and 24 hours post-exercise in vibration foam rolling after resistance exercise than in vibration foam rolling before resistance exercise and resistance exercise without vibration foam rolling. Knee flexion range of motion was significantly lower in resistance exercise without vibration foam rolling than in vibration foam rolling after resistance exercise at 24 and 48 hours post-exercise. Conclusions The application of vibration foam rolling after resistance exercise was more effective than that before exercise in decreasing muscle damage markers, reducing muscle stiffness, and improving the range of motion.

Purpose: Neonatal nurses are expected to have clinical competency to provide qualified and safe care for high-risk infants. An educational intervention to enhance nurses’ clinical competence is often a priority in the nursing field. This study was conducted to explore nurses’ perceived importance and performance confidence of nursing care activities in neonatal intensive care units. Methods: One hundred forty-one neonatal nurses from seven hospitals across South Korea participated in the online survey study. The scale of neonatal nursing care activity consisted of 8 subdomains including professional practice (assessment, diagnosis, planning, intervention, evaluation, education, research, and leadership). The Importance-Performance Matrix was used to analyze the importance of and confident performance in each of the nursing subdomains. Results: Both importance and performance confidence increased as nurses’ age (p=.042 and p<.001) and clinical experience (p=.004 and p<.001). Participants scored relatively higher in importance and performance confidence in the professional practice subdomains (assessment, intervention, evaluation), but scored lower in the education and research subdomains. Conclusion To provide evidence-based nursing care for high-risk infants in neonatal intensive care units, educational interventions should be developed to support nurses based on the findings of the research.

Purpose: This study was conducted to understand the unmet needs and quality of life of colorectal cancer survivors immediately after the end of primary treatment and 5 years later. Methods: This study was designed as a cross-sectional, descriptive, and correlation study. Data collection was conducted from July 2021 to December 2021. A total of 256 colorectal cancer survivors participated in the study, including 121 immediately after treatment and 135 five years later, among survivors of colorectal cancer who visited colorectal surgery outpatient clinics at two hospitals in Korea. We investigated unmet needs and quality of life immediately after the end of treatment and after five years. Data were assessed by using self-reported structured questionnaires. Results: It was confirmed that colorectal cancer survivors had higher unmet needs and lower quality of life immediately after the end of treatment than after 5 years. Additionally, regardless of the period after the end of treatment, the higher the unmet needs, the lower the quality of life. Conclusion Based on the results of this study, when developing and applying nursing interventions for managing colorectal cancer survivors, it will be helpful to improve the quality of life by identifying differences in unmet needs for each survival period.

Purpose: Fear of cancer recurrence (FCR) is a common psychological issue in breast cancer (BC) survivors during early survivorship but whether the same is true among long-term survivors has yet to be empirically evaluated. This study investigated FCR level, its associated factors, and impact on quality of life (QoL) in long-term BC survivors. Materials and Methods: Participants included women diagnosed with BC between 2004 and 2010 at two tertiary hospitals. Survey was conducted in 2020. The study measured FCR with the Fear of Cancer Recurrence Inventory and other patient-reported outcomes, including depression and cancer-related QoL. Logistic regression was used to identify factors associated with FCR, and structural equation modeling was conducted to explore the impact of FCR on other outcomes. Results: Of 333 participants, the mean age at diagnosis was 45.5, and 46% experienced FCR. Age at diagnosis ≤ 45 (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.51 to 4.60), shorter time since diagnosis (aOR, 1.75, 95% CI, 1.08 to 2.89), and having a history of recurrence (aOR, 2.56; 95% CI, 1.16 to 5.65) was associated with more FCR. FCR was significantly associated with an increased risk of depression (β=0.471, p < 0.001) and negatively impacted emotional functioning (β=–0.531, p < 0.001). In addition, a higher FCR level may impair overall health-related QoL in long-term BC survivors (β=–0.108, p=0.021). Conclusion Ten years after diagnosis, long-term BC survivors still experienced a high level of FCR. Further, the negative impact of FCR on QoL and increased depression risk require an FCR screening and appropriate interventions to enhance long-term BC survivors' QoL.

Purpose: To evaluate the effect of a gymnastics program for eight weeks to maintain better body composition and decrease fatigue among factory workers. Methods: Data were collected in 54 female workers in their 50s and 60s in a factory located in the S city of the K region between April and July in 2019. The subjects were divided into two groups: 1) experimental group (n=27) received a 30 minute-gymnastics program three times per week, and 2) control group participated in lecture series about the principle and effect of the gymnastics program. Body composition and fatigue levels were measured before and after the intervention and analyzed using the SPSS 23.0 program. To evaluate the differences in demographic and clinical characteristics between the experimental and control groups, the chi-squared test and the t-test were used. Repeated measures two-way ANOVA was performed to evaluate the change between outcomes of the pre-and post-investigation. Pairwise comparisons were used to assess the differences between the groups and the time. Results: There are statistically significant differences in body fat mass (p<.001), body fat percentage (p<.001), basal metabolic rate (p<.001), and body mass index (p<.022) in the experimental group compared to the control group. In particular, there is a significant interaction between the groups and the time in body fat mass (F=6.308, p=.015), basal metabolic rate (F=11.397, p=.001), fatigue (F=6.933, p=.011). Conclusion Our findings suggest that using the gymnastics program helps women in their 50s and 60s who work in factories promote better body composition and reduce fatigue levels.

Objective: : While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. Methods: : This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. Results: : A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. Conclusion : This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

Objective: : While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. Methods: : This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. Results: : A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. Conclusion : This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.