Effectiveness of a healthy lifestyle program based on a mobile serious game for childhood cancer survivors: A quasi-randomized trial.

PURPOSE: This study aimed to develop and evaluate the effectiveness of a healthy lifestyle program based on a mobile serious game (HLP-MSG) to enhance the lifestyles of childhood cancer survivors (CCSs). METHODS: This program proceeded in two stages: development and evaluation, using a non-synchronized design with a quasi-randomized trial. The participants were CCSs aged 6-13 years whose treatment was terminated at least 12 months prior. Data were collected at baseline, and post-intervention, with a follow-up after four weeks using the Child Healthy Lifestyle Profile (CHLP). The experimental (n = 26) and control groups (n = 25) were compared. Data were analyzed using descriptive statistics, chi-squared tests, t-tests, and repeated-measures ANOVA. RESULTS: The HLP-MSG promoted a healthy lifestyle by solving 26 quests, including seven sub-elements (nutrition, exercise, hygiene, interpersonal relationships, stress management, meaning of life, and health responsibility). This study revealed significant differences in the interaction between measurement time and group assignment in the CHLP (p = .006) and physical activity (p = .013), one of the seven sub-dimensions. CONCLUSIONS: A healthy lifestyle program based on a mobile serious game is a feasible health education modality to enhance the physical, psychological, social, and spiritual health of CCSs. IMPLICATIONS TO PRACTICE: The findings add to scientific evidence on a mobile serious game for health education among CCSs. The HLP-MSG provides an evolutionary educational modality that can be delivered non-face-to-face to promote CCSs' continuous healthy behavior maintenance. Moreover, the HLP-MSG is adolescent-friendly and can be utilized as a healthcare tool for parents and children to cooperate.

Differences in risk of generalized anxiety disorder according to physical activity type in Korea adolescents: The Korea youth risk behavior web-based survey, 2020-2021.

Objective: This study aimed to analyze the association between the types of physical activity (PA) and the level of generalized anxiety disorder (GAD) in Korean adolescents. Methods: This study analyzed data from the Korea Youth Risk Behavior Web-based Survey (KYRBS) for, 2020-2021. The dependent variable was the level of generalized anxiety disorder-7 (GAD-7). The GAD-7 scores were divided into four levels: normal, mild, moderate, and severe. The independent variables were moderate PA, vigorous PA, and strength exercises. Sex, school grade, body mass index, stress, depression, suicidal thoughts, violent victimization, drinking, smoking, substance abuse, sleep satisfaction, and sedentary time were selected as confounding variables. Results: The independent variable and all confounding variables showed significant differences with the level of GAD-7 (all p < .001). After adjusting for all confounding variables, we observed a 1.062 elevation in mild anxiety disorders, a 1.147 increase in moderate anxiety disorders, and a 1.218 increased incidence of severe anxiety disorders in the absence of vigorous PA. In the absence of strength exercises, there was a 1.057 elevation in mild anxiety disorders, a 1.110 increase in moderate anxiety disorders, and a 1.351 increased incidence of severe anxiety disorders. However, in the case of moderate PA, after adjusting for confounding variables, there was no significant association with GAD-7 levels. Conclusion: To prevent anxiety disorders among Korean adolescents, the type of PA should be considered. Vigorous PA or strength exercises may help prevent GAD in Korean adolescents.

Increased Risk of Generalized Anxiety Disorder According to Frequent Sedentary Times Based on the 16th Korea Youth Risk Behavior Web-Based Survey.

This study aimed to identify the association between sedentary behavior and anxiety disorders in 53,510 Korean adolescents. It analyzed data from the 16th (2020) Korea Youth Risk Behavior Web-based Survey (KYRBS). The dependent variable was the generalized anxiety disorder-7 (GAD-7). The GAD-7 scores were divided into normal, mild, moderate, and severe levels. The independent variables were sedentary time for learning, other sedentary times, total sedentary time, and regular physical activity. The confounding variables were sex, grade, stress, depression, substance abuse, suicidal thoughts, violent victimization, drinking, smoking, sleep satisfaction, and smartphone addiction. A chi-squared test, one-way analysis of variance, and logistic regression analysis were used for analysis. After adjusting for all confounding variables, the risk of severe level in GAD-7 increased by 1.045 times each time the sedentary time for learning based on increased by one hour. In other sedentary time and total sedentary time, the risk of severe level in GAD-7 increased by 1.025 times and 1.045 times per hour, respectively. However, in regular physical activity, after adjusting for the confounding variables, there was no significant association with the GAD-7 levels. Therefore, to prevent generalized anxiety disorders in Korean adolescents, it is necessary to reduce the overall sedentary times including sedentary time for learning.

Effects of Short-Term Intake of Montmorency Tart Cherry Juice on Sleep Quality after Intermittent Exercise in Elite Female Field Hockey Players: A Randomized Controlled Trial.

The purpose of this study was to investigate the effect of short-term consumption of tart cherry juice on levels of cortisol and melatonin and sleep quality after intermittent exhaustion exercise in female elite field hockey players. A total of 19 field hockey players participated in the present study for 5 days. The individuals were divided into the placebo group (PLA, n = 9) and the tart cherry juice group (TCJ, n = 10), respectively. Actigraphy devices were distributed to analyze sleep quality and participants were required to wear the device while sleeping until the study was completed. Participants consumed tart cherry juice or placebo drinks five times in a total of 48 h while double-blinded after intermittent exhaustion exercise. A significant interaction effect (group × time) between PLA and TCJ groups was not observed in the levels of melatonin and cortisol. The variables of sleep quality showed significant interaction effects with regards to the total time in bed (TTB; p = 0.015), wake after sleep onset (WASO; p = 0.044), and movement index (MI; p = 0.031) variables. As a result, our study confirmed the possibility that the short-term intake of tart cherry juice could not change the levels of melatonin and cortisol in elite female hockey players but could help improve their sleep quality.

Relationship between Smartphone Addiction and Sleep Satisfaction: A Cross-Sectional Study on Korean Adolescents.

The purpose of this study was to analyze the relationship between smartphone addiction and sleep satisfaction in 54,948 Korean adolescents. This study utilized the Korea Youth Risk Behavior Web-Based Survey (KYRBS). The dependent variable was sleep satisfaction. Independent variables were smartphone addiction level and usage time. Gender, school grade, stress, depression, regular physical activity (PA), asthma, allergic rhinitis, and atopic dermatitis were selected as confounding variables. A chi-squared test, logistic regression, and independent t-test were performed for data analysis. As a result of the chi-squared test, sleep satisfaction showed significant relationships with all confounding variables (all p < 0.001). As a result of adjusting all confounding variables, sleep satisfaction of smartphone normal users was significantly higher (odds ratios: 1.372, p < 0.001) than that of high-risk users with smartphone addiction. Smartphone users with a daily smartphone usage time from 2 h to 8 h a day were 1.096−1.347 times (p = 0.014 to p < 0.001) more likely to be satisfied with their sleep than smartphone users with a daily smartphone usage time over 8 h, who were unsatisfied with their sleep. The group that was not satisfied with their sleep had a significantly higher average daily smartphone usage time and total score on the smartphone addiction scale than the group that was satisfied with their sleep (both p < 0.001). In conclusion, it will be necessary to manage the use of smartphones to improve the sleep satisfaction of Korean adolescents.

The Association between Physical Activity and Smartphone Addiction in Korean Adolescents: The 16th Korea Youth Risk Behavior Web-Based Survey, 2020.

Many side effects of smartphone addiction have been reported, such as a lack of sleep, obesity, and poor concentration. However, the relationship between physical activity (PA) and smartphone addiction has not been fully elucidated. This study aimed to analyze the relationship between physical activity and smartphone addiction among 53,534 Korean adolescents using raw data from the 16th (2020) Korea Youth Risk Behavior Web-based Survey (KYRBS). The dependent variables were the general user group, potential risk user group, and high-risk user group for smartphone addiction. The independent variables were moderate PA (over 5 days per week), vigorous PA (over 3 days per week), and strength exercise (over 3 days per week). Sex, body mass index (BMI), school grade, academic achievement, sleep satisfaction, depression, loneliness, and stress were selected as confounding variables. A complex sample logistic regression analysis was performed. Potential smartphone addiction risk users showed statistically significant odds ratios of 1.423 (p < 0.001), 1.379 (p < 0.001), and 1.383 (p < 0.001) based on general users participating in moderate PA, vigorous PA, and strength exercise, respectively. High-risk users showed statistically significant odds ratios of 1.475 (p < 0.001), 1.484 (p < 0.001), and 1.619 (p < 0.001), respectively. In conclusion, to prevent smartphone addiction among Korean adolescents, participation in moderate PA for more than five days a week, vigorous PA for more than three days a week, or strength exercise for more than three days a week is considered effective.

Aged Lumbar Extension Strength of Chronic Low Back Pain in Korean Population of 10-80 Years.

BACKGROUND: The purpose of this study was to find the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of low back pain (LBP) patients. METHODS: In this cross-sectional study, 3078 chronic LBP participants from The J hospital, Seoul, Republic of Korea, from 2003 to 2010 were enrolled. Maximum muscle strength was measured at maximum flexion angle and maximum extension angle according to range of motion (ROM) results. For each isometric test, participants were seated and secured in the MEDX (medx lumbar extension machine, Ocala, FL, USA) machine. RESULTS: The relative ROM (P=0.012) differed significantly among the aged groups in all participants. In addition, mean of strength (P<0.001), maximal of strength (P<0.001), mean of strength %BW (P<0.001) and maximal of strength %BW (P<0.001) are significant differences in all participants. The results of multiple regression analysis was the 'model A', maximal of strength for 32.1% of the variance in weigh, body mass index and range of motion. In addition, 'model B' was 30.4%, 'model C' was 28.8%, 'model D' was 28.5%, 'model E' was 21.7%, and 'model F' was 23.5% of the variance in weigh, body mass index and range of motion. CONCLUSION: We found the three predictor (weight, BMI, and ROM) variables accounted for 32.1% of the variance in maximal of strength %BW, the highest in < 29 yr groups. Our data indicate the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of LBP patients.

Curcumin supplementation and delayed onset muscle soreness (DOMS): effects, mechanisms, and practical considerations.

PURPOSE: In this literature review we aimed to investigate the effects of curcumin supplementation on delayed onset muscle soreness (DOMS), which occurs after exercise, and evaluate related parameters to propose practical recommendations for the field of exercise physiology. METHODS: Experimental studies conducted on curcumin supplementation and DOMS were systematically reviewed to determine (1) the effect of curcumin supplementation on DOMS, (2) potential mechanisms by which curcumin supplementation may attenuate DOMS, and (3) practical considerations for curcumin supplementation. RESULTS: While several studies have reported that curcumin supplementation attenuates DOMS after exercise, others have reported that curcumin supplementation has no effect on DOMS. Several mechanisms have been proposed by which curcumin supplementation may attenuate DOMS; the most probable of which is a reduction in inflammatory response. Other potential mechanisms include modulation of transient receptor potential vanilloid 1 (TRPV1) or changes in post-exercise capillary lactate levels; these require further examination. The usual recommended dose of curcumin is 150-1500 mg daily (sometimes up to 5 g), divided into 2-3 portions and taken before and after exercise. It is not necessary to take curcumin together with piperine. CONCLUSION: Although conflicting results regarding the effects of curcumin supplementation on DOMS exist in literature, it may be considered as a method of nutritional intervention for reducing post-exercise DOMS.

Prevalence of sports injuries in Korean fencers aged 14-40 years.

BACKGROUND: Although sites and types of injury frequently occurring in fencers have been well described, the type of injury caused by the use of fencing movements is still unknown. This study aimed to provide basic data for injury prevention by understanding the sports injury status in fencers. METHODS: A total of 584 South Korean fencers were included in the survey and were classified according to the injured site, cause of injury, and movement that causes injury. The collected data were analyzed using frequency analysis, χ2 tests, and logistic regression analysis to identify differences in sex, event type, age, and career. RESULTS: Female (P=0.001) and foil fencers (P=0.015) were more likely to experience injury than male and sabre and epee fencers. The incidence of injury was significantly higher according to age (P=0.001) and career (P=0.001). The ankle was the most frequently injured site (17.71%). Injuries most frequently occur during Fente movement (48.11%). Insufficient warm-up was the most common cause of injury (23.91%) in all groups. CONCLUSIONS: These results suggest that a specific warm-up program and strengthening exercises of the ankle and knee ligaments should be established to prevent injuries for fencers. Particularly, female, foil, adult, and experienced fencers should be more careful in preventing injuries.

The acute effects of different frequencies of whole-body vibration on arterial stiffness.

Whole-body vibration (WBV) can decrease arterial stiffness, but the effects of low-frequency WBV on arterial stiffness are not known. The aim of this study was to clarify the acute effects on arterial stiffness of WBV by vibration frequency. This study involved 9 healthy men (age: 31 ± 7 years). Each WBV session involved 3 sets of 4 different vibrations (0 Hz [control], 12 Hz, 20 Hz, 30 Hz) lasting 60 s with a 60-s inter-session rest interval. During WBV, the participants adopted a static squat position with their knees bent. An automatic oscillometric device was used to measure brachial-ankle pulse wave velocity (baPWV) before (baseline) and 5, 15, and 30 min after WBV. There was a significant decrease in baPWV from baseline at 30 min (P = .02) after WBV at 30 Hz. However, there was no change in baPWV at any time points after WBV at 0 (control), 12, and 20 Hz. These results suggested that low-frequency WBV does not affect arterial stiffness.

Electrically evoked local muscle contractions cause an increase in hippocampal BDNF.

High-intensity exercise has recently been shown to cause an increase in brain-derived neurotropic factor (BDNF) in the hippocampus. Some studies have suggested that myokines secreted from contracting skeletal muscle, such as irisin (one of the truncated form of fibronectin type III domain-containing protein 5 (FNDC5)), play important roles in this process. Thus, we hypothesized that locally evoked muscle contractions may cause an increase of BDNF in the hippocampus through some afferent mechanisms. Under anesthesia, Sprague-Dawley rats were fixed on a custom-made dynamometer and their triceps surae muscles were made to maximally contract via delivery of electric stimulations of the sciatic nerve (100 Hz with 1-ms pulse and 3-s duration). Following 50 repeated maximal isometric contractions, the protein expressions of BDNF and activation of its receptor in the hippocampus significantly increased compared with the sham-operated control rats. However, the expression of both BDNF and FNDC5 within stimulated muscles did not significantly increase, nor did their serum concentrations change. These results indicate that local muscular contractions under unconsciousness can induce BDNF expression in the hippocampus. This effect may be mediated by peripheral reception of muscle contraction, but not by systemic factors.

Activation of AMP-activated protein kinase induce expression of FoxO1, FoxO3a, and myostatin after exercise-induced muscle damage.

AMP-activated protein kinase (AMPK) has been shown to regulate protein metabolism in skeletal muscle. We previously found that levels of Forkhead box proteins, FoxO1 and FoxO3a, and myostatin in rat gastrocnemius increased after exercise-induced muscle damage (EIMD). Eccentric muscle contractions (ECs), defined as elongation of muscle under tension, were used for inducing EIMD. The objective of this study was to clarify whether AMPK participates in activation and expression of FoxO proteins and myostatin in rat gastrocnemius muscle after EIMD. Wistar rats were randomly assigned into the following three groups; CON (n = 6), 180ECs group (ankle angular velocity, 180°/s; n = 6), and 30ECs group (ankle angular velocity, 30°/s; n = 6). 20 ECs were conducted with percutaneous electrical stimulation of gastrocnemius and simultaneous forced dorsiflexion of ankle joint (from 0° to 45°). To evaluate activation of AMPK, we measured the phosphorylated states of AMPK and acetyl CoA carboxylase. For evaluation of the direct relationships of AMPK and other proteins, we also examined contents of FoxOs and myostatin with stimulation of L6 myotube with AMPK agonist, 5 -aminoimidazole -4 -carboxamide -1-ß-d-ribofuranoside (AICAR) (0.1, 0.5, 1, 1.5, and 2 mM). Western blotting was employed for protein analysis. Significant torque deficit was only observed in the 180ECs, suggesting EIMD. We also observed that phosphorylated AMPKα was induced in response to 180ECs (p < 0.01 vs. CON). Additionally, the level of phosphorylated acetyl CoA carboxylase was significantly higher in response to 180ECs and 30ECs. The phosphorylated states of FoxO1, FoxO3a, and myostatin expression were increased significantly in response to 180ECs. Furthermore, treatment of L6 myotubes with AICAR showed similar tendencies to that observed in in vivo gastrocnemius muscle treated with 180ECs. Therefore, we conclude that activation of AMPK plays a key role in increasing the level of FoxO1, FoxO3a, and myostatin in gastrocnemius after EIMD.

The ACTN3 R577X genotype is associated with muscle function in a Japanese population.

Homozygosity for the common nonsense polymorphism R577X in the α-actinin-3 gene (ACTN3) causes complete α-actinin-3 deficiency in fast-twitch skeletal muscle fibers. This study investigated whether the ACTN3 R577X polymorphism affects fitness status using a battery of tests in a large Japanese cohort. In the present study, 1227 subjects (age: 25-85 years) were genotyped for the ACTN3 R577X polymorphism (rs1815739) using a TaqMan SNP genotyping assay (Applied Biosystems). All subjects were divided into 2 groups based on their age (<55 years and ≥55 years). All subjects completed a questionnaire about exercise habits and were subjected to a battery of tests to assess their fitness status (including grip strength test, chair stand test, and 8-foot walking test). A significant association between the ACTN3 R577X genotype and chair stand test performance was observed in the group of men ≥55 using ANCOVA adjusted for age and exercise habits (p = 0.036). The ACTN3 R577X genotype accounted for 2.5% of the variability in the results of the chair stand test among men in the ≥55 age group. Moreover, for the ≥55 age group, performance in the chair stand test was lower among those with the XX genotype than among those with the RR genotype (p = 0.024) or RX genotype (p = 0.005), unlike results for the <55 age group. No significant difference was noted for hand grip strength or 8-foot walking time. Thus, our results suggest that the ACTN3 R577X genotype is associated with lower-extremity muscle function in the Japanese population.

Eccentric contractions of gastrocnemius muscle-induced nerve damage in rats.

INTRODUCTION: We examined the effects of gastrocnemius eccentric contractions (ECs) on the sciatic nerve in rats. METHODS: Rats were divided randomly into the following 3 groups: control, 180EC (ECs with 180°/s angular velocity), and 30EC (ECs with 30°/s angular velocity). Twenty ECs were induced by electrical stimulation of the gastrocnemius. On days 3, 7, and 10 after the ECs, nerve conduction velocity (NCV) was measured, and sciatic nerve branches were harvested for analysis. RESULTS: A significant decrease in NCV was observed between the control and day-7 180EC. Significant reduction in the levels of myelin sheath protein zero (p0) between day 7 and day 3 180EC and a significant increase of macrophage-related protein and tyrosine kinase receptor C were observed between day 7 180EC and day 7 30EC. CONCLUSIONS: ECs with fast angular velocities induce functional and structural damage in innervating nerve.

Effect of intermittent low-frequency electrical stimulation on the rat gastrocnemius muscle.

Low-frequency neuromuscular electrical stimulation (NMES) has been used as an endurance exercise model. This study aimed to test whether low-frequency NMES increases the phosphorylation of anabolic signaling molecules and induces skeletal muscle hypertrophy, as seen with high-frequency NMES. Using Sprague-Dawley rats, 1 bout of exercise (with dissection done immediately (Post0) and 3 h (Post3) after exercise) and another 6 sessions of training were performed. All experimental groups consisted of high- and low-frequency stimulation (HFS: 100 Hz; LFS: 10 Hz). Periodic acid-Schiff (PAS) staining was conducted to investigate type II fiber activation, and western blot analysis (WB) was conducted to examine whether NMES leads to anabolic intracellular signaling. At first, we examined the acute effect of exercise. PAS staining revealed that glycogen depletion occurred in both type I and type II fibers. WB results demonstrated that p70S6K phosphorylation was significantly increased by HFS, but there was no significant difference with LFS. In contrast, ERK 1/2 phosphorylation was increased by LFS at Post0. In the 6-session training, the wet weight and myofibrillar protein were significantly increased by both HFS and LFS. In conclusion, LFS has a similar anabolic effect for skeletal muscle hypertrophy as HFS, but the mediating signaling pathway might differ.

Proposed new mechanism for food and exercise induced anaphylaxis based on case studies.

We present two cases of food and exercise-induced anaphylaxis (FEIA) in patients with a diagnosis of oral allergy syndrome (OAS) to the implicated foods. Patient A had FEIA attributed to fresh coriander and tomato and Patient B to fresh celery. These food allergens have been implicated in OAS and have structural antigenic similarity to that of birch and/or grass. Both patients' allergies were confirmed by fresh skin prick tests. In both cases, strenuous exercise was antecedent to the systemic anaphylaxis reaction and subsequent ingestion without exercise produced only local symptoms of perioral pruritus. We review the current proposed mechanisms for food and exercise induced anaphylaxis to oral allergens and propose a novel and more biologically plausible mechanism. We hypothesize that the inhibitory effects of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves structural integrity, thereby allowing continued systemic absorption of the allergen whether it be profilins, lipid transfer proteins, or other antigenic determinants.

mTOR signaling response to resistance exercise is altered by chronic resistance training and detraining in skeletal muscle.

Resistance training-induced muscle anabolism and subsequent hypertrophy occur most rapidly during the early phase of training and become progressively slower over time. Currently, little is known about the intracellular signaling mechanisms underlying changes in the sensitivity of muscles to training stimuli. We investigated the changes in the exercise-induced phosphorylation of hypertrophic signaling proteins during chronic resistance training and subsequent detraining. Male rats were divided into four groups: 1 bout (1B), 12 bouts (12B), 18 bouts (18B), and detraining (DT). In the DT group, rats were subjected to 12 exercise sessions, detrained for 12 days, and then were subjected to 1 exercise session before being killed. Isometric training consisted of maximum isometric contraction, which was produced by percutaneous electrical stimulation of the gastrocnemius muscle every other day. Muscles were removed 24 h after the final exercise session. Levels of total and phosphorylated p70S6K, 4E-BP1, rpS6, and p90RSK levels were measured, and phosphorylation of p70S6K, rpS6, and p90RSK was elevated in the 1B group compared with control muscle (CON) after acute resistance exercise, whereas repeated bouts of exercise suppressed those phosphorylation in both 12B and 18B groups. Interestingly, these phosphorylation levels were restored after 12 days of detraining in the DT group. On the contrary, phosphorylation of 4E-BP1 was not altered with chronic training and detraining, indicating that, with chronic resistance training, anabolic signaling becomes less sensitive to resistance exercise stimuli but is restored after a short detraining period.

Characteristics of myogenic response and ankle torque recovery after lengthening contraction-induced rat gastrocnemius injury.

BACKGROUND: Although muscle dysfunction caused by unfamiliar lengthening contraction is one of most important issues in sports medicine, there is little known about the molecular events on regeneration process. The purpose of this study was to investigate the temporal and spatial expression patterns of myogenin, myoD, pax7, and myostatin after acute lengthening contraction (LC)-induced injury in the rat hindlimb. METHODS: We employed our originally developed device with LC in rat gastrocnemius muscle (n = 24). Male Wistar rats were anesthetized with isoflurane (aspiration rate, 450 ml/min, concentration, 2.0%). The triceps surae muscle of the right hindlimb was then electrically stimulated with forced isokinetic dorsi-flexion (180°/sec and from 0 to 45°). Tissue contents of myoD, myogenin, pax7, myostatin were measured by western blotting and localizations of myoD and pax7 was measured by immunohistochemistry. After measuring isometric tetanic torque, a single bout of LC was performed in vivo. RESULTS: The torque was significantly decreased on days 2 and 5 as compared to the pre-treatment value, and recovered by day 7. The content of myoD and pax7 showed significant increases on day 2. Myogenin showed an increase from day 2 to 5. Myostatin on days 5 and 7 were significantly increased. Immunohistochemical analysis showed that myoD-positive/pax7-positive cells increased on day 2, suggesting that activated satellite cells play a role in the destruction and the early recovery phases. CONCLUSION: We, thus, conclude that myogenic events associate with torque recovery after LC-induced injury.

Design of a computerized provider order entry system for ordering of chemotherapy.

With the developments in medical information systems and the widespread establishment of medical information systems that include computerized order communication systems (OCSs), there has been an increase in the establishment of computerized chemotherapy order systems. In this study, we aim to design an improved computerized provider order entry (CPOE) system that integrates a chemotherapy ordering system that can issue a customized order in response to a provider's diverse chemotherapy prescription needs with an automated issuance of dosage, treatment schedule, and treatment method. We expect the newly designed system to be able to prevent the common errors in complex chemotherapy ordering systems and reduce the time required for ordering.