Development and evaluation of a forensic nursing competency-based hybrid simulation education program: A quasi-experimental design.

AIM: This study aimed to develop and validate the effectiveness of a hybrid simulation education program designed to enhance the forensic nursing competency of emergency department nurses. BACKGROUND: Emergency nurses often bear the responsibility of conducting forensic nursing assessments and interventions, such as patient recognition and evidence collection, to safeguard patients' legal rights, given their frequent encounters with emergency department patients. Simulation methods have proven effective in training for forensic nursing care. However, there is still a need for the development of forensic nursing education using simulation methods. DESIGN: This study employed a one-group pre-test/post-test quasi-experimental design. A four-hour simulation education program was developed based on the analysis, design, development, implementation, and evaluation model, with a focus on enhancing forensic nursing competency. METHODS: Nurses with more than six months of clinical experience in the emergency department in South Korea were divided into an experimental group (n=23) and a baseline comparison group (n=24). Both groups completed self-evaluations of their forensic nursing competency through a survey. The experimental group underwent the simulation education program, and their forensic nursing performance was evaluated before and after the program. Following the training, participants completed a questionnaire to assess their forensic nursing competency and satisfaction with the program. RESULTS: The initial forensic nursing competency of the experimental and baseline comparison groups was found to be similar. However, the forensic nursing competency and performance of the experimental group exhibited significant improvement after the training. Regarding program evaluation, the average scores on a 5-point scale were as follows: theoretical lecture (4.79 SD 0.27), simulation education (4.78 SD 0.29), simulation design (4.42 SD 0.45), and satisfaction with the educational program (4.82 SD 0.28). CONCLUSIONS: The forensic nursing competency-based simulation education program herein improved the relevant competency and performance of emergency nurses.

Krill Oil's Protective Benefits against Ultraviolet B-Induced Skin Photoaging in Hairless Mice and In Vitro Experiments.

Krill oil (KO) shows promise as a natural marine-derived ingredient for improving skin health. This study investigated its antioxidant, anti-inflammatory, anti-wrinkle, and moisturizing effects on skin cells and UVB-induced skin photoaging in hairless mice. In vitro assays on HDF, HaCaT, and B16/F10 cells, as well as in vivo experiments on 60 hairless mice were conducted. A cell viability assay, diphenyl-1-picryhydrazyl (DPPH) radical scavenging activity test, elastase inhibition assay, procollagen content test, MMP-1 inhibition test, and hyaluronan production assay were used to experiment on in vitro cell models. Mice received oral KO administration (100, 200, or 400 mg/kg) once a day for 15 weeks and UVB radiation three times a week. L-Ascorbic acid (L-AA) was orally administered at 100 mg/kg once daily for 15 weeks, starting from the initial ultraviolet B (UVB) exposures. L-AA administration followed each UVB session (0.18 J/cm2) after one hour. In vitro, KO significantly countered UVB-induced oxidative stress, reduced wrinkles, and prevented skin water loss by enhancing collagen and hyaluronic synthesis. In vivo, all KO dosages showed dose-dependent inhibition of oxidative stress-induced inflammatory photoaging-related skin changes. Skin mRNA expressions for hyaluronan synthesis and collagen synthesis genes also increased dose-dependently after KO treatment. Histopathological analysis confirmed that krill oil (KO) ameliorated the damage caused by UVB-irradiated skin tissues. The results imply that KO could potentially act as a positive measure in diminishing UVB-triggered skin photoaging and address various skin issues like wrinkles and moisturization when taken as a dietary supplement.

The effects of a mobile application for patient participation to improve patient safety.

BACKGROUND: Patient participation in patient safety activities in care processes is a fundamental element of safer care. Patients play an important role in preventing patient safety incidents and improving health outcomes. Therefore, healthcare providers need to develop and provide educational materials and actionable tools for patient participation. OBJECTIVES: This study aimed to develop a mobile application for health consumers' participation and evaluate the effect of the mobile application on improving health consumers' participation in patient safety. METHODS: A quasi-experimental design was adopted. We developed a mobile application on the basis of a needs assessment, literature review, compilation of patient safety topics, and validity testing of the application. The target population included Korean adults aged between 30 and 65 years who had visited a medical institution more than once within the most recent 6 months. The intervention group received patient participation training by using the mobile application, Application for Patient Participation in Safety Enhancement, for 2 months. The primary outcome variables were patient safety knowledge, self-efficacy of participation, willingness to participate and experience of patient participation in patient safety activities. End-user satisfaction was assessed using a questionnaire. To assess participants' experiences with the intervention, qualitative data were collected through a focus group interview and open-ended responses to an end-user satisfaction survey. RESULTS: The intervention group (n = 60) had significantly higher overall average scores than the control group (n = 37) with regard to patient safety knowledge (p < .001), self-efficacy of participation (p = .001), willingness to participate (p = .010) and experience of participation (p = .038) in the post-survey. The total mean end-user satisfaction score was 3.56 ± 0.60. The participants expressed the realization that patients could play an important role in improving patient safety. CONCLUSIONS: This study demonstrated that educating health consumers through a mobile application with useful information improves patient participation in patient safety activities. Educational materials and patient participation tools could motivate health consumers' health-related behaviours. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved during the programme development and evaluation.

Communication education regarding patient safety for registered nurses in acute hospital settings: a scoping review protocol.

INTRODUCTION: The importance of correct and timely communication continues to be emphasised in the area of patient safety. Nurses play a key role in communicating with a variety of healthcare personnel to deliver safe care for patients. Many attempts have been made to improve nursing professionals' communication competencies regarding patient safety. However, the scope, method and effectiveness of communication education regarding patient safety for registered nurses have not been sufficiently reviewed. In order to understand the overall status of this field, a scoping review with a systematic framework is necessary. The objective of this study is to map the extent, range and nature of literature on communication education regarding patient safety for registered nurses in acute hospital settings and identify gaps to guide future research, policy and practice. METHODS AND ANALYSIS: This study will be conducted in accordance with the methodology for scoping reviews developed by Arksey and O'Malley. To strengthen its rigour, the scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The overall review process will involve an independent review by two reviewers to select and analyse literature. The databases to be explored are MEDLINE (Ovid), Embase, Education Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Korean Medical Database (KMBASE). In addition, we will endeavour to include the grey literature through manual searches on patient safety-related websites. This review will target literature on communication programmes for patient safety provided to registered nurses in acute hospital settings and will include peer-reviewed literature in English and Korean since 2000, when research in the field of patient safety started to increase rapidly. ETHICS AND DISSEMINATION: Since this study is a review of previous studies, no ethics approval is required. The findings of the study will be disseminated in a peer-reviewed journal for publication.

Development and Evaluation of a Teamwork Improvement Program for Perioperative Patient Safety.

BACKGROUND: Effective teamwork in healthcare teams improves quality of care, which positively impacts on patient safety. Teamwork is especially crucial for perioperative nurses because they provide care as a team in the operating room. Previous research on teamwork training has principally addressed the general aspects of healthcare settings and focused on interdisciplinary teamwork and has rarely considered operative settings and nursing teamwork. PURPOSE: The aim of this study was to develop a teamwork improvement program for perioperative patient safety and to evaluate the effectiveness of this program. METHODS: A quasi-experimental design was applied. We developed a teamwork improvement program based on teamwork competencies that focused on the perioperative nursing practice. This research was conducted at two operating centers in a tertiary hospital in South Korea, and a total of 60 perioperative nurses participated, including 28 nurses from the cancer operating center (experimental group) and 32 nurses from the main operating center (control group). The program consisted of four sessions and was delivered to the experimental group for a period of 2 weeks. Following the intervention, the effectiveness of the intervention was measured using a self-report questionnaire, focus group interviews, and program evaluation survey. Data were analyzed using chi-square test, t test, Fisher's exact test, and content analysis. RESULTS: Nearly all (96.4%) of the participants were satisfied with the overall content of the teamwork improvement program. Statistically significant differences were found between the experimental and control groups with regard to teamwork knowledge, teamwork attitudes, communication self-efficacy, and teamwork skills and behaviors. Three themes were elicited from the qualitative analysis, including "recognizing the importance and content of teamwork," "improving teamwork competencies," and "contributing to safe surgery." No significant difference in the incidence of surgical nursing errors was identified between the experimental and control groups within a 4-week period. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The teamwork improvement program developed in this study was demonstrated as effective in improving perioperative nurses' utilization of teamwork competencies in nursing practice and positively changing teamwork. The findings of this study provide evidence that teamwork training increases nurses' teamwork competencies. The clinical application of teamwork tools using competency-based teamwork training may contribute to patient safety and safe nursing practice.

Comparative analysis of core muscle activation according to the use of props and the different knee angle during the modified Pilates Hundred.

BACKGROUND: There are not so many Pilates studies related to muscle activation. Since the effectiveness and efficiency of the Pilates Hundred to muscle activation has recently emerged, it is necessary to investigate the effects of the Pilates Hundred on core muscles. OBJECTIVES: The purpose of this study was to determine what difference occurs in the muscle activity, during the Pilates Hundred, to suggest the optimal props for muscle function improvement and then to provide data for the efficient exercise program. METHODS: Twenty-eight men in their twenties who were able to fully conduct Pilates Hundred. According to the difference between the small tool application (no prop: NP, soft ball mini: SB, Pilates ring: PR) and the knee joint angle (90° and 180°), muscle activations of rectus abdominis (RA), external oblique (EO), rectus femoris (RF), lateral muscle (vastus lateralis: VL), medial muscle (vastus medialis: VM), biceps femoris (BF), and semitendinosus (ST) were measured by the using surface electromyography (EMG) while different exercise conditions. RESULTS: During Pilates Hundred, the use of tools was found to be more effective in activating the core muscle (NP < SB < PR). During Pilates Hundred, 180° of knee angle had more influence on core muscle activation than 90°, and knee angle and props use showed an interaction for activating core muscles. CONCLUSION: The Pilates Hundred with PR and 180° knee angle intervention can increase core muscle activation, and this leads to effective Pilates exercise program for those who need to enhance core muscle volume and function and to rehabilitate core muscles.

Effects of applied swan pilates motions on upper body muscle activities.

BACKGROUND: There have been very few studies involving swan motion during pilates exercises, and there is also insufficient scientific evidence to support the fact that Pilates swan motion strengthens specific muscles. OBJECTIVES: Firstly, the purpose of this study was to evaluate the effect of 5 types Pilates swan motion (swan basic (SB), swan push-up (SP), swan holding posture (SH), form roller-based swan (SF), and circle-based swan (SC)) on muscle activity of deltoideus p. acromialis (DA), infraspinatus (IP), trapezius (TP), latissimus dorsi (LD), and erector spinae (ES). Secondly, the purpose of this study was to suggest an effective Pilates swan motion for strengthening muscle strength of each targeted muscle. METHODS: Twenty-four healthy men in their 20s participated and all participants were measured muscle activity in DA, IP, TP, LD, and ES muscles by electromyography (EMG) during 5 Pilates swan motions (SB, SP, SH, SF, & SC). The measured values were expressed as relative voluntary contraction (%RVC) values based on the SB. RESULTS: The %RVC values representing the muscle activity of DA and TP were significantly higher in SH and SP than in SC, SF, and SB (p < .001). The %RVC values of IP and LD were significantly higher in SH and SC than in SF, SP, and SB (p < .001). The %RVC value of ES was were significantly higher in SH than in SP, SC, SF, and SB (p < .001). CONCLUSION: The application of SP, SC, and SH Pilates swan motion is an effective method to activate the back muscles of the trunk.

Interventions to Engage Patients and Families in Patient Safety: A Systematic Review.

The involvement of patients and families is essential for improving patient safety. However, the role of patients and caregivers in patient safety has recently been receiving attention, and programs and interventions have been implemented for patients and caregivers. The objective of this systematic review was to identify the types of interventions to improve patient safety that focused on engaging patients and their families, and the effectiveness of these interventions. Searching four electronic databases, 2019 articles were obtained; of these, 15 articles met the inclusion criteria. The studies used intervention strategies at the "information" and "involvement" engagement levels. Interventions with strategies only at the information level mostly measured safety perception and were mostly found to be effective. Interventions with both information and involvement strategies measured more diverse outcomes, but their effectiveness was inconsistent. Further studies using a range of intervention strategies and outcomes with more rigorous methodologies are needed.PROSPERO registration number CRD42018096162.

Mixed-method investigation of health consumers' perception and experience of participation in patient safety activities.

OBJECTIVES: This study aimed to examine the factors influencing patient safety behaviours and to explore health customers' experiences of patient participation in the healthcare system. DESIGN: A mixed-method sequential explanatory design was employed using a survey and focus group interviews with health consumers. SETTING: The study was conducted in South Korea using an online survey tool. PARTICIPANTS: Survey data were collected from 493 Korean adults, aged 19 years or older, who had visited hospitals within the most recent 1 year. Focus group interviews were conducted in two groups of six participants each among those of the survey participants who agreed to participate in focus groups. MAIN OUTCOME MEASURES: The survey measured the recognition of the importance of participation, extent of willingness to participate and experience of engaging in patient safety activities using a 4-point Likert scale. Qualitative data were collected through focus group interviews to explore health consumers' experience of patient participation in hospital care, and the data were analysed using content analysis. RESULTS: The average score for experience of participation in patient safety behaviours (2.13±0.63) was found to be lower than those of recognition of the importance of participation (3.27±0.51) and willingness to participate (2.62±0.52). By integrating the results of the quantitative and qualitative data analysis, the factors associated with the experience of engaging in healthcare behaviour included patient-related factors, illness-related factors, factors involving relationship between patients and healthcare providers, and healthcare environment factors. CONCLUSIONS: To improve patient participation, it is necessary to create a healthcare environment in which patients can speak comfortably and to provide an education programme reflecting the patients' needs. Also, healthcare providers must consider patients as partners for patient safety. Shared decision-making procedures and patient-centred care and patient safety policies should be established in hospitals.

Comparative Studies on Patient Safety Culture to Strengthen Health Systems Among Southeast Asian Countries.

Patient safety is an important issue in health systems worldwide. A systematic review of previous studies on patient safety culture in Southeast Asian countries is necessary for South Korea's partnership with these countries, especially given South Korea's assistance in strengthening the health systems of these developing countries. Studies on patient safety culture in Southeast Asian countries, published in English and Thai languages, were retrieved from computerized databases using keywords through a manual search. Data extraction, quality assessment, and analyses were performed using several tools. The review included 21 studies conducted in Indonesia (n = 8), Thailand (n = 5), Malaysia (n = 3), Vietnam (n = 2), Singapore (n = 1), and the Philippines (n = 1). They were analyzed and categorized into 12 dimensions of safety culture, and differences in response rate or scores were identified compared to the mean of the dimensions. The heterogeneous of safety culture's situation among Southeast Asian countries, both in practice and in research, can be explained since patient safety policy and its application are not prioritized as much as they are in developed countries in the priority compared to the developed countries. However, Vietnam, Cambodia, Myanmar, and Laos are the priority countries for South Korea's official healthcare development assistance in the Southeast Asia region. Vietnam, for instance, is an economically transitioning country; therefore, consolidated patient safety improvement by inducing patient safety culture in the provincial and central health system as well as strengthening project formulation to contribute to health policy formation are needed for sustainable development of the partner countries' health systems. It is recommended that more evidence-based proactive project planning and implementation be conducted to integrate patient safety culture into the health systems of developing countries, toward health policy on patient safety and quality service for the attainment of sustainable development goals in South Korea's development cooperation.

Requirement Analysis for Developing a Patient Participation Program in Patient Safety.

Patients' roles in preventing errors has been emphasized. Patients' and families' participation is one of the important strategies to improve patient safety. Therefore, it is necessary to educate patients and families who visit hospitals. Web-based educational programs can be useful tools to provide patient safety information easily and enhance patients' and families' knowledge. This study analyzed requirements for developing a web-based program for patient participation in patient safety.

Distinct molecular evolution of influenza H3N2 strains in the 2016/17 season and its implications for vaccine effectiveness.

Influenza virus is a respiratory pathogen that causes seasonal epidemics by resulting in a considerable number of influenza-like illness (ILI) patients. During the 2016/17 season, ILI rates increased unusually earlier and higher than previous seasons in Korea, and most viral isolates were subtyped as H3N2 strains. Notably, the hemagglutinin (HA) of most Korean H3N2 strains retained newly introduced lysine signatures in HA antigenic sites A and D, compared with that of clade 3C.2a vaccine virus, which affected antigenic distances to the standard vaccine antisera in a hemagglutination inhibition assay. The neuraminidase (NA) of Korean H3N2 strains also harbored amino acid mutations. However, neither consistent amino acid mutations nor common phylogenetic clustering patterns were observed. These suggest that Korean H3N2 strains of the 2016/17 season might be distantly related with the vaccine virus both in genotypic and phenotypic classifications, which would adversely affect vaccine effectiveness.

Effects of resistance exercise on antioxidant enzyme activities and apoptosis-related protein expression of hippocampus in OLETF rats.

BACKGROUND: Studies on antioxidant enzyme activity and apoptosis related protein expression associated with diabetes are mainly limited to aerobic exercise. Since the effectiveness and efficiency of the resistance to diabetes has recently emerged, it is necessary to investigate the effects of regular resistance exercise on these factors. OBJECTIVE: The purpose of this study was to investigate the effects of resistance exercise on antioxidant enzymes activities and apoptosis related protein expression in hippocampus of diabetic rats. METHODS: Twenty-one male rats were divided into 3 groups: LETO (control group), OLETF (diabetes group) and OLETF + EX (OLETF with resistance exercise group). Resistance exercise consisted of ladder climbing every 5 days for 30 minutes for 8 weeks. The exercise group was trained to climb a 180-cm vertical ladder with weights secured to their tails. Antioxidant enzyme activities, apoptosis related protein expression, and HOMA-IR level were measured. RESULTS: The lipid peroxide and superoxide dismutase (SOD) activity were significantly increased in OLETF + EX compared to OLETF (p< 0.001). Glutathione peroxidase (GPx) activity was significantly lower in OLETF + EX than OLETF (p< 0.001). Caspase-3 expression of hippocampus was significantly decreased in OLETF + EX compared to OLETF (p< 0.05). Bax protein expression was significantly lower in OLETF + EX than OLETF (p< 0.05) whereas Bcl-2 expression was significantly higher in OLETF + EX than OLETF (p< 0.05). HOMA-IR level was significantly decreased in OLETF + EX compared to OLETF (p< 0.05). CONCLUSIONS: Regular resistance exercise intervention can decrease oxidative stress by enhancing antioxidant enzyme activity and this may lead to attenuate apoptosis related protein such as caspase-3, bax and bcl-2 expression in hippocampus of diabetic population.

Hepatoprotective and anti-obesity effects of Korean blue honeysuckle extracts in high fat diet-fed mice.

PURPOSE: This study aimed to study the protective effects and mechanism of Blue Honeysuckle (BH) extracts (Berries of Lonicera caerulea L.) on non-alcoholic fatty liver disease (NAFLD) and obesity risk factors in a high fat-diet (HFD) model. METHODS: Animals adapted to HFD were selected after 1 week of adaption period and divided into 6 groups (8 mice in each group; 40 HFD-fed mice and 8 normal fat pellet diet (NFD)-fed mice). After the end of 12 weeks of continuous oral administrations of 3 different dosages of BH extract, 400, 200 and 100 mg/kg, or metformin 250 mg/kg, dissolved in a volume of 10 mL/kg distilled water, the hepatoprotective, hypolipidemic, hypoglycemic, nephroprotective, and anti-obesity effects were analyzed. RESULTS: The BH extract improved fat density and mass, adipocyte histopathology, hepatocyte hypertrophy, hepatic enzyme activity, lipid metabolism, and related gene expression including ACC1, AMPK α1 and AMPK α2 in hepatic tissue, leptin, UCP2, adiponectin, C/EBP α, C/EBPß and SREBP1c in adipose tissue. Especially, 200 mg/kg of BH extract constantly improved NAFLD and obesity risk factors through AMPK upregulation-mediated hepatic glucose enzyme activity, lipid metabolism-related gene expression, and activation of the antioxidant defense system, to a level comparable to that of metformin 250 mg/kg in HFD-fed mice. CONCLUSION: BH extract has the potential to reduce the risk factors associated with obesity, in addition to the remarkable effect of preventing NAFLD. Future research will need to be done to determine whether these results are consistent in human studies.

Hippotherapy and neurofeedback training effect on the brain function and serum brain-derived neurotrophic factor level changes in children with attention-deficit or/and hyperactivity disorder.

PURPOSE: The purpose of this study was to investigate the effect of hippotherapy and electroencephalography (EEG) neurofeedback on brain function and blood brain-derived neurotrophic factor (BDNF) level in children with attention-deficit or/and hyperactivity disorder (ADHD). METHODS: Sixteen children with ADHD participated in this study and were randomly divided into 2 groups, a 1-time hippotherapy group (W1G, n = 8) and a 2-time hippotherapy group (W2G, n = 8). All the participants attended 8 weeks of hippotherapy program in the primary training, and then 7 children with ADHD attended 8 weeks of hippotherapy program combined with neurofeedback training in the secondary training. Blood BDNF levels were measured, and functional magnetic resonance imaging (fMRI) was performed. The EEG neurofeedback training program was used to train and measure psychological factors. RESULTS: The combined effect of hippotherapy and neurofeedback on BDNF level showed a decreased tendency in W1G (pretraining, 1766.03 ± 362.54 pg/ml; posttraining, 1630.65 ± 276.70 pg/ml). However, the BDNF level of W2G showed an increased tendency (pretraining, 1968.28 ± 429.08 pg/ml; posttraining, 1976.28 ± 425.35 pg/ml). Moreover, combined training showed a significant group x repetition interaction in W1G (pretraining, 1436.57 ± 368.76 pg/ml; posttraining, 1525.23 ± 346.22 pg/ml; F = 3.870, p = 0.039). fMRI results showed that the left thalamus activity in both groups had a decreased tendency and a significantly lower change in W2G than in W1G (p < 0.05). CONCLUSION: This study confirmed a significant increase in blood BDNF level after combined training, which may induce brain function improvement in children with ADHD.

Patient safety competency and educational needs of nursing educators in South Korea.

BACKGROUND: Nursing educators must be qualified to teach patient safety to nursing students to ensure patient safety in the clinical field. The purpose of this study was to assess nursing educators' competencies and educational needs for patient safety in hospitals and nursing schools. METHOD: A mixed-methods sequential explanatory design employed a survey and focus group interview with nursing educators (school clinical instructors and hospital nurse preceptors). Thirty-eight questionnaires filled out by clinical instructors from six four-year nursing universities and 106 questionnaires from nurse preceptors from three high-level general hospitals in the Seoul metropolitan area were analyzed to obtain quantitative data. Focus group interviews were conducted among six clinical instructors from one nursing school and four nurse preceptors from one high-level general hospital in Seoul. RESULTS: Nursing educators had higher levels of attitude compared with relatively lower levels of skill and knowledge regarding patient safety. They reported educational needs of "medication" and "infection prevention" as being higher and "human factors" and "complexity of systems" as being lower. Nursing educators desired different types of education for patient safety. CONCLUSION: It is necessary to enhance nursing educators' patient safety skills and knowledge by developing and providing an integrated program of patient safety, with various teaching methods to meet their educational needs. The findings of this study provide the basic information needed to reform patient safety education programs appropriately to fit nursing educators' needs and their patient safety competencies in both clinical practice and academia. Furthermore, the findings have revealed the importance of effective communication between clinical and academic settings in making patient safety education seamless.

Interaction of ACTN3 gene polymorphism and muscle imbalance effects on kinematic efficiency in combat sports athletes.

PURPOSE: The purpose of this study was to determine the interaction of ACTN3 gene polymorphism and muscle imbalance effects on kinematic efficiency changes in combat sports athletes. METHODS: Six types of combat sports athletes (Judo, Taekwondo, boxing, kendo, wrestling, and Korean Ssi-reum) participated in the study. ATCN3 gene polymorphism and muscle imbalance in lower extremity were evaluated followed by analysis of differences of moment in hip, knee, and ankle joint during V-cut jumping and stop. To examine the moment difference due to an interaction of ATCN3 polymorphism and muscle imbalance, all participants were divided into 4 groups (R+MB, R+MIB, X+MB, and X+MIB). RESULTS: There was no significant difference of hip, knee, and ankle joint moment in R allele and X allele during V-cut jumping and stop based on ACTN3 gene polymorphism. Otherwise, muscle imbalance of knee moment in X-axis and ground reaction force of knee in Z-axis showed a higher significance in muscle imbalance during V-cut jumping and stop compared to muscle balance (p<0.05). In addition, joint analysis showed that muscle imbalance in X allele group had significantly higher knee moment of V-cut ground reaction force in X-axis and higher ankle moment of jumping ground reaction force in X and Z-axis compared to muscle balance with R and/or X group (p <0.05). CONCLUSION: This study confirmed that muscle imbalance in lower extremity of combat athletes might induce higher risk factors of sports injury incidence than genetic factor and training might reduce the ratio of sports injury risk incidence.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

OBJECTIVE: The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. METHODS: We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. RESULTS: A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). CONCLUSIONS: Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals.

Hepatoprotective effects of hoveniae semen cum fructus extracts in ethanol intoxicated mice.

PURPOSE: The objective of this study was to evaluate the hepatoprotective effects of Hoveniae Semen Cum Fructus extract in ethanol induced hepatic damages. METHODS: Hepatic damages were induced by oral administration of ethanol and then Hoveniae Semen Cum Fructus extract was administered. RESULTS: Following Hoveniae Semen Cum Fructus extract administration, body and liver weights were increased, while aspartate aminotransferase, alanine aminotransferase, albumin, γ-glutamyl transferase, and triglyceride levels in the serum, triglyceride contents, tumor necrosis factor -α level, cytochrome (CY) P450 2E1 activity in the liver and mRNA expression of hepatic lipogenic genes, and Nitrotyrosine and 4-HNE-immunolabelled hepatocytes were decreased. However, mRNA expression of genes involved in fatty acid oxidation was increased. Also, as a protective mechanism for hepatic antioxidant defense systems, decreased liver MDA contents, increased glutathione contents, increased dismutase and catalase activities were observed when compared to the ethanol control. CONCLUSION: Hoveniae Semen Cum Fructus extract favorably protected against liver damages, mediated by its potent anti-inflammatory and anti-steatosis properties through the augmentation of the hepatic antioxidant defense system by NF-E2-related factor-2 activation, and down-regulation of the mRNA expression of hepatic lipogenic genes or up-regulation of the mRNA expression of genes involved in fatty acid oxidation.