Objective: This study aims to understand the structure of meaning in life among patients with cancer through the validation of the Meaning in Life Scale among Korean patients (K-MiLS) with cancer. Methods: From August 2021 to November 2022, participants were recruited from multiple sites in South Korea. Participants completed related questionnaires, including the MiLS, on the web or mobile. Test-retest reliability was assessed between 2 and 4 weeks after the initial assessment. Exploratory and confirmatory factor analyses and Pearson’s correlations were used to evaluate the reliability and validity of the MiLS. A multiple regression analysis was conducted to examine the sociodemographic and disease-related variables correlated with the MiLS. Regarding concurrent validity, a hierarchical regression analysis was performed. Results: The results (n=345) indicated that the K-MiLS has a four-factor structure: Harmony and Peace; Life Perspective, Purpose, and Goals; Confusion and Lessened Meaning; and Benefits of Spirituality. Regarding convergent and discriminant validity, K-MiLS was negatively correlated with Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Fear of Cancer Recurrence Inventory while showing a significantly positive correlation with the Posttraumatic Growth Inventory, Self-Compassion Scale, Functional Assessment of Cancer Therapy-General, and Functional Social Support Questionnaire. Hierarchical regression analysis revealed that the demographic variable influencing MiLS was religious affiliation. Conclusion The K-MiLS had a multidimensional four-factor structure similar to that of the original version. It is also a reliable and valid measure for assessing cancer survivors’ meaning in life after a cancer diagnosis.

Objective: This study aims to understand the structure of meaning in life among patients with cancer through the validation of the Meaning in Life Scale among Korean patients (K-MiLS) with cancer. Methods: From August 2021 to November 2022, participants were recruited from multiple sites in South Korea. Participants completed related questionnaires, including the MiLS, on the web or mobile. Test-retest reliability was assessed between 2 and 4 weeks after the initial assessment. Exploratory and confirmatory factor analyses and Pearson’s correlations were used to evaluate the reliability and validity of the MiLS. A multiple regression analysis was conducted to examine the sociodemographic and disease-related variables correlated with the MiLS. Regarding concurrent validity, a hierarchical regression analysis was performed. Results: The results (n=345) indicated that the K-MiLS has a four-factor structure: Harmony and Peace; Life Perspective, Purpose, and Goals; Confusion and Lessened Meaning; and Benefits of Spirituality. Regarding convergent and discriminant validity, K-MiLS was negatively correlated with Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Fear of Cancer Recurrence Inventory while showing a significantly positive correlation with the Posttraumatic Growth Inventory, Self-Compassion Scale, Functional Assessment of Cancer Therapy-General, and Functional Social Support Questionnaire. Hierarchical regression analysis revealed that the demographic variable influencing MiLS was religious affiliation. Conclusion The K-MiLS had a multidimensional four-factor structure similar to that of the original version. It is also a reliable and valid measure for assessing cancer survivors’ meaning in life after a cancer diagnosis.

Objective: This study aims to understand the structure of meaning in life among patients with cancer through the validation of the Meaning in Life Scale among Korean patients (K-MiLS) with cancer. Methods: From August 2021 to November 2022, participants were recruited from multiple sites in South Korea. Participants completed related questionnaires, including the MiLS, on the web or mobile. Test-retest reliability was assessed between 2 and 4 weeks after the initial assessment. Exploratory and confirmatory factor analyses and Pearson’s correlations were used to evaluate the reliability and validity of the MiLS. A multiple regression analysis was conducted to examine the sociodemographic and disease-related variables correlated with the MiLS. Regarding concurrent validity, a hierarchical regression analysis was performed. Results: The results (n=345) indicated that the K-MiLS has a four-factor structure: Harmony and Peace; Life Perspective, Purpose, and Goals; Confusion and Lessened Meaning; and Benefits of Spirituality. Regarding convergent and discriminant validity, K-MiLS was negatively correlated with Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Fear of Cancer Recurrence Inventory while showing a significantly positive correlation with the Posttraumatic Growth Inventory, Self-Compassion Scale, Functional Assessment of Cancer Therapy-General, and Functional Social Support Questionnaire. Hierarchical regression analysis revealed that the demographic variable influencing MiLS was religious affiliation. Conclusion The K-MiLS had a multidimensional four-factor structure similar to that of the original version. It is also a reliable and valid measure for assessing cancer survivors’ meaning in life after a cancer diagnosis.

Objective: This study aims to understand the structure of meaning in life among patients with cancer through the validation of the Meaning in Life Scale among Korean patients (K-MiLS) with cancer. Methods: From August 2021 to November 2022, participants were recruited from multiple sites in South Korea. Participants completed related questionnaires, including the MiLS, on the web or mobile. Test-retest reliability was assessed between 2 and 4 weeks after the initial assessment. Exploratory and confirmatory factor analyses and Pearson’s correlations were used to evaluate the reliability and validity of the MiLS. A multiple regression analysis was conducted to examine the sociodemographic and disease-related variables correlated with the MiLS. Regarding concurrent validity, a hierarchical regression analysis was performed. Results: The results (n=345) indicated that the K-MiLS has a four-factor structure: Harmony and Peace; Life Perspective, Purpose, and Goals; Confusion and Lessened Meaning; and Benefits of Spirituality. Regarding convergent and discriminant validity, K-MiLS was negatively correlated with Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Fear of Cancer Recurrence Inventory while showing a significantly positive correlation with the Posttraumatic Growth Inventory, Self-Compassion Scale, Functional Assessment of Cancer Therapy-General, and Functional Social Support Questionnaire. Hierarchical regression analysis revealed that the demographic variable influencing MiLS was religious affiliation. Conclusion The K-MiLS had a multidimensional four-factor structure similar to that of the original version. It is also a reliable and valid measure for assessing cancer survivors’ meaning in life after a cancer diagnosis.

Objective: This study aims to understand the structure of meaning in life among patients with cancer through the validation of the Meaning in Life Scale among Korean patients (K-MiLS) with cancer. Methods: From August 2021 to November 2022, participants were recruited from multiple sites in South Korea. Participants completed related questionnaires, including the MiLS, on the web or mobile. Test-retest reliability was assessed between 2 and 4 weeks after the initial assessment. Exploratory and confirmatory factor analyses and Pearson’s correlations were used to evaluate the reliability and validity of the MiLS. A multiple regression analysis was conducted to examine the sociodemographic and disease-related variables correlated with the MiLS. Regarding concurrent validity, a hierarchical regression analysis was performed. Results: The results (n=345) indicated that the K-MiLS has a four-factor structure: Harmony and Peace; Life Perspective, Purpose, and Goals; Confusion and Lessened Meaning; and Benefits of Spirituality. Regarding convergent and discriminant validity, K-MiLS was negatively correlated with Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Fear of Cancer Recurrence Inventory while showing a significantly positive correlation with the Posttraumatic Growth Inventory, Self-Compassion Scale, Functional Assessment of Cancer Therapy-General, and Functional Social Support Questionnaire. Hierarchical regression analysis revealed that the demographic variable influencing MiLS was religious affiliation. Conclusion The K-MiLS had a multidimensional four-factor structure similar to that of the original version. It is also a reliable and valid measure for assessing cancer survivors’ meaning in life after a cancer diagnosis.

Background and Objectives: This study aimed to evaluate the factors that influence deep sleep restoration in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. Methods: In total, 363 patients diagnosed with OSA who received PAP therapy over at least 3 months were enrolled in the study. Polysomnographic parameters, anatomical characteristics, and subjective sleep-related parameters were evaluated according to the presence of daytime sleepiness and morning headache before and after 3 months of PAP treatment. Results: Age was significantly different according to whether excessive daytime sleepiness (EDS) was alleviated (average: 49.35 years) or persisted (average: 52.82 years) (p=0.001). Age was also significantly associated with morning headache (p=0.037). Body mass index (BMI) was higher in the alleviated EDS group (28.70 kg/m2) than in the persistent EDS group (27.13 kg/m2; p=0.002). The apnea-hypopnea index (AHI) was correlated with the EDS outcome (p=0.011). The group with alleviated EDS had a longer mandibular plane to hyoid distance (MPH) than the group with persistent EDS (17.95 mm vs. 15.38 mm; p<0.001). However, BMI, AHI, and MPH showed no significant associations with morning headache. Epworth Sleepiness Scale scores were higher in the alleviated EDS and alleviated morning headache groups (EDS: p<0.001, morning headache: p=0.001). Self-Efficacy Measure for Sleep Apnea (SEMSA) values differed significantly between the EDS groups (p<0.001), but not between the morning headache groups (p=0.122). After 3 months of PAP therapy, the MPH was negatively correlated with EDS in univariate (odds ratio [OR]=0.921, p<0.001) and multivariate analyses (OR=0.937, p=0.028). The SEMSA score was also negatively correlated with EDS in univariate (OR=0.961, p<0.001) and multivariate (OR=0.973, p=0.019) analyses. Conclusion Age, polysomnographic metrics, and anatomical considerations were important for sleep quality-associated daytime symptoms. In addition, anatomical characteristics and the patient’s self-efficacy were significantly associated with the effect of PAP treatment on sleep quality.

Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.

Purpose: This study investigated the correlation between non-mass-like enhancement (NME) observed on preoperative breast magnetic resonance imaging (MRI) and the actual pathological size of breast cancer. We further examined the effect of NME on the positive resection margins during partial mastectomy. Methods: We retrospectively collected data from breast cancer patients who underwent surgery between January 2018 and September 2020. Patients were divided into two groups based on their MRI findings: NME and no-NME (mass-like lesion only) groups. The medical records, including MRI findings and clinicopathological information of patients, were collected retrospectively, and correlations with pathologic results were analyzed. Propensity score matching was applied to develop comparable cohorts of the NME group and no-NME group. Results: This study included a total of 317 patients, with 66 and 251 patients in the NME and no-NME groups, respectively. The mean pathologic size of invasive lesion was significantly smaller than the mean lesion size in the NME group (1.55±1.39 cm vs. 3.45±1.81 cm, p<0.001). The mean pathologic size of ductal carcinoma in situ (DCIS) lesions was larger than that in the NME group but without statistical significance (3.91±2.67 cm vs. 3.50±1.79 cm, p=0.326). In the NME group, NME estimated DCIS size to within 1 cm in 20 patients (30.3%) and overestimated invasive lesion size by more than 1 cm in 31 patients (46.9%). NME (vs. no-NME; odds ratio [OR], 2.967; 95% confidence interval [CI], 0.878-10.025) showed a tendency to predict positive resection margins, but this was not statistically significant (p=0.080). Conclusion NME findings on MRI showed a similar extent of DCIS lesions. NME findings on preoperative MRI should be considered an important factor for measuring the extent of tumors, especially in DCIS patients.

Purpose: Patients undergoing pancreatoduodenectomy are a high-risk group that requires psychosocial support. This study retrospectively reviewed the prevalence of psychological symptoms in patients undergoing pancreatoduodenectomy for periampullary neoplasm and the psychosocial referral rate after implementing full screening and triage algorithm for administering a distress management protocol based on the integrated supportive care system established in 2010. Materials and Methods: From September 2010 to December 2018, insomnia, anxiety, and depression were screened on the first day of admission (T1) and on the 10th postoperative day (T2). Patients with clinical levels of distress were referred to a mental health clinic for appropriate aftercare. Results: The adherence rate to routine screening was 82.7% (364/440). Among the 364 patients, the prevalence of insomnia, anxiety, and depression increased from 22.0% (T1) to 32.6% (T2, p=0.001), 29.1% to 33.6% (p=0.256), and 18.4% to 27.6% (p=0.001), respectively. Less than 45% of those with psychological symptoms expressed their needs for psychological supportive care. Among those with psychological symptoms at T2, clinical insomnia, anxiety, and depression were detected via in-depth evaluations among 77.2%, 38.1%, and 82.5% of patients, respectively. Patients who had two or more symptoms at T2 had a longer postoperative hospital stay, as compared to those with one or no symptoms (a median of 20.5 days vs. 18.0 days, p=0.006). Psychiatric consultation rate was 72.8% among patients with clinical psychological symptoms, and 74% of the consulted patients completed psychiatric intervention before discharge. Conclusion Over one-third of the patients had psychological symptoms before and after pancreatoduodenectomy. Implementing a routine psychological symptoms screening with a systematic psychiatric referral protocol enhanced surgeons’ responsiveness to patients’ psychological symptoms.

Background: It is necessary to develop a roadmap for antimicrobial usage monitoring in order to perform monitoring of antimicrobial use at the national level properly. Therefore, this study aimed to develop a roadmap for establishing surveillance and monitoring of antimicrobial use in medical institutions at the national level. Materials and Methods: A modified Delphi study was conducted, including 3 rounds of an online survey and a virtual meeting with 16 expert panels. The survey items were developed based on a literature review of the surveillance systems for antimicrobial use in 12 countries and interviews with experts. The questionnaire was designed to include both the surveillance and benchmarking systems. Results: Regarding the scope of target institutions to be included in the surveillance system, medical institutions for sentinel surveillance had the highest proportion of agreement among the panels (75.0%, 9/12). For the benchmarking system, “tertiary- and secondarycare hospitals” were accepted as the scope of target institutions at the current moment.Furthermore, the National Health Insurance claims and prescription data of individual hospitals were considered appropriate data sources for the surveillance system. As for the measures to promote the participation of hospitals in the benchmarking system, “compensation through the establishment of antimicrobial management fees” and “set the participation in the program as a quality evaluation or accreditation index for hospital evaluation” were accepted. Conclusion This study provides a roadmap for establishing an antimicrobial use monitoring and benchmarking system for medical institutions at a national level in Korea.