A framework for nationwide COVID-19 vaccine safety research in the Republic of Korea: the COVID-19 Vaccine Safety Research Committee

With the introduction of coronavirus disease 2019 (COVID-19) vaccines, the Korea Disease Control and Prevention Agency (KDCA) commissioned the National Academy of Medicine of Korea to gather experts to independently assess post-vaccination adverse events. Accordingly, the COVID-19 Vaccine Safety Research Committee (CoVaSC) was launched in November 2021 to perform safety studies and establish evidence for policy guidance. The CoVaSC established 3 committees for epidemiology, clinical research, and communication. The CoVaSC mainly utilizes pseudonymized data linking KDCA’s COVID-19 vaccination data and the National Health Insurance Service’s claims data. The CoVaSC’s 5-step research process involves defining the target diseases and organizing ad-hoc committees, developing research protocols, performing analyses, assessing causal relationships, and announcing research findings and utilizing them to guide compensation policies. As of 2022, the CoVaSC completed this research process for 15 adverse events. The CoVaSC launched the COVID-19 Vaccine Safety Research Center in September 2022 and has been reorganized into 4 divisions to promote research including international collaborative studies, long-/short-term follow-up studies, and education programs. Through these enhancements, the CoVaSC will continue to swiftly provide scientific evidence for COVID-19 vaccine research and compensation and may serve as a model for preparing for future epidemics of new diseases.

Is a New Public Medical School Linked to Compulsory Service Necessary to Strengthen Public Health Care in Korea?: Who Wants to Build a New Public Medical School Linked to Compulsory Service? And Why? / 의학교육논단

The purpose of this study is to clarify the background of the controversial attempt to establish a new public medical school linked to compulsory service as a means of strengthening public healthcare in Korea, and to raise anticipated problems with possible solutions. In Korea, healthcare is predominantly provided by the private sector focused on medical care, rather than public healthcare, even under the national health insurance system. The government has been mainly in charge of public health and unmet medical services from a residual perspective, but health inequalities still exist. To resolve this issue, the government created the concept of public health and medical service (PHMS) from a universal perspective and tried to strengthen the infrastructure of public healthcare and to foster core PHMS doctors by establishing a new public medical school linked to compulsory service in medically vulnerable areas. This study investigated the reality and concept of the new public medical school planned by the government, and identified problems such as the possibility of obtaining accreditation and evaluation before its establishment, the side effects of dividing doctors’ roles, the waste of huge amounts of resources, and insensitive policies. In conclusion, in order to resolve health inequalities in Korea, we need to train doctors through medical school education that strengthens the social responsibility of doctors along with strengthening public healthcare infrastructure, and to provide a better environment for doctors working in medically vulnerable areas through sophisticated policies.

Burnout of Faculty Members of Medical Schools in Korea

Background@#There is no national survey on medical school faculty members’ burnout in Korea. This study aimed to investigate burnout levels and explore possible factors related to burnout among faculty members of Korean medical schools. @*Methods@#An anonymous online questionnaire was distributed to 40 Korean medical schools from October 2020 to December 2020. Burnout was measured by a modified and revalidated version of the Maslach Burnout Inventory-Human Service Survey. @*Results@#A total of 996 faculty members participated in the survey. Of them, 855 answered the burnout questions, and 829 completed all the questions in the questionnaire. A significant number of faculty members showed a high level of burnout in each sub-dimension: 34% in emotional exhaustion, 66.3% in depersonalization, and 92.4% in reduced personal accomplishment. A total of 31.5% of faculty members revealed a high level of burnout in two sub-dimensions, while 30.5% revealed a high level of burnout in all three sub-dimensions.Woman faculty members or those younger than 40 reported significantly higher emotional exhaustion and depersonalization. Long working hours (≥ 80 hours/week) showed the highest reduced personal accomplishment scores (F = 4.023, P = 0.018). The most significant stressor or burnout source was “excessive regulation by the government or university.” The research was the most exasperating task, but the education was the least stressful. @*Conclusion@#This first nationwide study alerts that a significant number of faculty members in Korean medical schools seem to suffer from a high level of burnout. Further studies are necessary for identifying the burnout rate, related factors, and strategies to overcome physician burnout.

How the coronavirus disease 2019 pandemic changed medical education and deans’ perspectives in Korean medical schools / 한국의학교육

Purpose@#This study explored how the Korean Medical Colleges responded to the coronavirus disease 2019 (COVID-19) pandemic and the medical deans’ perspectives on what and how these adaptions influence the present and the future of medical education. @*Methods@#An email survey combining short and open-ended questions was distributed to all 40 Korean school deans in May 2020. Thirty-seven deans out of 40 medical schools in Korea (92.5%) participated. @*Results@#Most lectures moved online but students’ assessments were delayed and later held onsite. Clinical rotations continued except for an average of 3-week suspension during the first COVID-19 wave. The deans’ remarks on the positive influences far outweighed the negative impact of COVID-19 on medical education. Although technological adaptations caused initial hardship, the experience gained through the use of various online learning systems led to attitudinal changes on the importance of adopting new technology and a tailored and student centric curriculum in medical education. @*Conclusion@#The deans’ perspective changes has shown the possibility of the deans’ generation aligning more closely with the current Generation Z medical students. They projected further innovations in teaching and learning methods, especially applying flipped learning and highlighted the need to invest in faculty development so medical educators can be equipped and competent in diverse ICT (information and communications technology) learning platforms. Also, the need for advance preparations in medical education for future similar public health crises were stressed. Unprecedented changes brought by COVID-19 positively impacted Korean medical education in parts and the Korean deans envisioned further innovations using the experiences gained during this crisis.

How the coronavirus disease 2019 pandemic changed medical education and deans’ perspectives in Korean medical schools / 한국의학교육

Purpose@#This study explored how the Korean Medical Colleges responded to the coronavirus disease 2019 (COVID-19) pandemic and the medical deans’ perspectives on what and how these adaptions influence the present and the future of medical education. @*Methods@#An email survey combining short and open-ended questions was distributed to all 40 Korean school deans in May 2020. Thirty-seven deans out of 40 medical schools in Korea (92.5%) participated. @*Results@#Most lectures moved online but students’ assessments were delayed and later held onsite. Clinical rotations continued except for an average of 3-week suspension during the first COVID-19 wave. The deans’ remarks on the positive influences far outweighed the negative impact of COVID-19 on medical education. Although technological adaptations caused initial hardship, the experience gained through the use of various online learning systems led to attitudinal changes on the importance of adopting new technology and a tailored and student centric curriculum in medical education. @*Conclusion@#The deans’ perspective changes has shown the possibility of the deans’ generation aligning more closely with the current Generation Z medical students. They projected further innovations in teaching and learning methods, especially applying flipped learning and highlighted the need to invest in faculty development so medical educators can be equipped and competent in diverse ICT (information and communications technology) learning platforms. Also, the need for advance preparations in medical education for future similar public health crises were stressed. Unprecedented changes brought by COVID-19 positively impacted Korean medical education in parts and the Korean deans envisioned further innovations using the experiences gained during this crisis.

The role of Korean Council on Medical Education and its future direction

This study was conducted to recognize the role of Korean Council on Medical Education (KCME), which is composed of 12 medical organizations related to medical education, and its importance in Korean medical society. The historical background of the establishment of the KCME is reviewed, along with changes in medical education in Korea starting in the early 1960s. In 1971, the first organization for medical education in Korea, the Association of Korean Medical Colleges, was established by 14 deans of medical colleges. This organization sought to create a good environment for medical education, but because of conflict between deans and medical educators, in 1983 it was divided into two organizations : the Korean Society of Medical Education and the Korean Council of Deans of Medical Colleges. Neither was active until they co-organized a congress about medical education in 1994, and fortunately, they have continued to collaborate since. At that time, the Korean government aggressively tried to authorize 9 new medical colleges, which caused Korean organizations related to medical education to unite against this governmental policy by establishing the KCME. The KCME played an important role in monitoring policy changes and achieved some noteworthy results. However, recent changes, including the fourth industrial revolution and patterns of mutual influence among medical education, research and clinical practice, have spurred the KCME to change and broaden its activities. Therefore, the KCME should take the lead in launching a serious discussion reorganizing Korean medical societies so that academic medicine and practical medicine may flourish.

The role of Korean Council on Medical Education and its future direction

This study was conducted to recognize the role of Korean Council on Medical Education (KCME), which is composed of 12 medical organizations related to medical education, and its importance in Korean medical society. The historical background of the establishment of the KCME is reviewed, along with changes in medical education in Korea starting in the early 1960s. In 1971, the first organization for medical education in Korea, the Association of Korean Medical Colleges, was established by 14 deans of medical colleges. This organization sought to create a good environment for medical education, but because of conflict between deans and medical educators, in 1983 it was divided into two organizations : the Korean Society of Medical Education and the Korean Council of Deans of Medical Colleges. Neither was active until they co-organized a congress about medical education in 1994, and fortunately, they have continued to collaborate since. At that time, the Korean government aggressively tried to authorize 9 new medical colleges, which caused Korean organizations related to medical education to unite against this governmental policy by establishing the KCME. The KCME played an important role in monitoring policy changes and achieved some noteworthy results. However, recent changes, including the fourth industrial revolution and patterns of mutual influence among medical education, research and clinical practice, have spurred the KCME to change and broaden its activities. Therefore, the KCME should take the lead in launching a serious discussion reorganizing Korean medical societies so that academic medicine and practical medicine may flourish.

The Concept of Academic Medicine and Its Potential Establishment in Korea / 의학교육논단

The purpose of this study was to introduce the concept of academic medicine to the medical societies of Korea and to identify any potential obstacles in the establishment of academic medicine in Korea. The core concepts of academic medicine include medical education, research, and patient care. Academic medicine can be practiced in the unique area of healthcare involving medical schools and teaching hospitals by faculty physicians in the academic medicine field. Through academic medicine, the next generation of healthcare professionals is trained, new discoveries can be made, and patients can find new hope for a cure. The flourishing of academic medicine has resulted in substantial advancements in medicine over the past few centuries, but at the turn of the 21st century, there was concern that academic medicine was on the decline. To address this concern, the International Campaign to Revitalize Academic Medicine was established and announced five scenarios to 2025 to debate the future of academic medicine. Although the system resembles that of Western medical societies, Korean medical societies were not familiar with academic medicine, and poor conditions caused by the distorted healthcare system in Korea have actually interfered with the nurturing of academic medicine. One of the main problems may include less interest in medical education and research relative to clinical practice by medical societies and the government. Collaborative efforts from both medical societies and the government are needed to establish academic medicine successfully in Korea for a better future.

A Weight Loading Device as a Method for Assessment of Unilateral Knee Pain

OBJECTIVE: To identify the effectiveness of a weight loading device as a method for assessment of unilateral knee pain. METHOD: Twenty-five patients with unilateral knee pain and 25 pain-free controls participated in this study. Patients with a score of 2 or more on modified Kellgren-Lawrence scale based on the radiologic findings were diagnosed as degenerative arthritis. We constructed a device of segmental foot plates with strain gauge weight sensors to measure the weight load of each leg during self-selected walking speed. Using this device, we obtained the ratio of symptomatic side to asymptomatic side of weight load (RATIO) for each patient. The degree of pain according to visual analogue scale (VAS), abnormalities in radiologic findings, and weight load ratio were compared with each other. RESULTS: The RATIO was 1.00+/-0.03 in the control group, and 0.92+/-0.08 in the patient group (p<0.05). In the patient group, there was a significant correlation between RATIO and the VAS score (r=-0.44, p=0.03). In the patient group with degenerative arthritis, the RATIO (p=0.75) and VAS (p=0.94) were not different from those in patient group without degenerative arthritis. CONCLUSION: The foot plate weight loading device may be an effective tool for convenient measurements of knee pain.

Peripheral Analgesic and Anti-inflammatory Effects of Diclofenac, SC-560 and NS-398 on Acute Arthritic Model in Rats / 대한마취과학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are generally attributed to suppression cyclooxygenase enzymes, leading to decreased products of the arachidonic acid cascade. Since the discovery of two isoenzymes of cyclooxygenase, inhibition of cyclooxygenase-2 has been suggested to be responsible for therapeutic effects of NSAIDs without side effects. In the present study, to investigate the extent to peripheral nociception and inflammation of cyclooxygenase-1 and cyclooxygenase-2, diclofenac (non-selective inhibitor), SC-560 (selective cyclooxygenase-1 inhibitor) and NS-398 (selective cyclooxygenase-2 inhibitor) are injected intra-articularly on acute arthritic model in rats. METHODS: Arthritis was induced with 2% lamda-carrageenan (suspended in 50microliter normal saline) into the right knee joint cavity under enflurane anesthesia (2-4%). Before and after the injection, rats were allowed to walk freely through a pathway constructed to record weight load by means of 8 weight sensors (strain gauge type) attached to 8 plates which function independently. The weight load, diameter of both knee joints and weight of rat were measured at each test. At 4 hours and 30 minutes, diclofenac, SC-560 and NS-398 dissolved in 10% dimethyl sulfoxide were injected intra-articularly (50microgram/50microliter). RESULTS: The weight loads increased in diclofenac group at 6 and 9 hours and in NS-398 group at 24 and 48 hours after induction of arthritis. The diameter ratio decreased in diclofenac group at 12 hours after induction of arthritis. CONCLUSIONS: These results suggest that peripheral nociception and inflammation in acute model of arthritis in rats are likely related with both cyclooxygenase-1 and cyclooxygenase-2 pathways.

Effects of Sex Hormones on Nociception and the Analgesic Action of NSAIDs / 대한마취과학회지

BACKGROUND: The effects of sex hormones on nociception and the analgesic actions of non-steroidal anti-inflammatory drugs (NSAIDs) in an acute arthritic pain model were investigated. METHODS: Rats were ovariectomized and randomly assigned to three experimental groups. The estrogen group (n = 45) received a 0.25 mg pellet of 17beta-estradiol, the placebo group (n = 45) received a 0.25 mg pellet of a placebo and the progesterone group (n = 45) received a 25 mg pellet of progesterone. Arthritis was induced by injecting 2% carrageenan into the knee joint cavity of the right hind leg. Before and after the injection, rats were allowed to walk freely through a weight load apparatus. The weight load and the weight of the rat were measured for each test. One hour after injection, ibuprofen or NS-398, dissolved in dimethyl sulfoxide, was injected intraperitoneally (1 mg/kg/ml). RESULTS: The carrageenan injection into the knee joint cavity of the right hind leg of the rat resulted in a significant decrease in the weight load on the injected leg. Estrogen-treated rats showed lower weight load reduction than the placebo and progesterone groups, NS-398 increased the weight load compared to rats not receiving NSAIDs. CONCLUSIONS: These results suggest that the nociceptive response after acute inflammation was reduced by estrogen, and that only NS-398 had a good analgesic effect in the placebo and progesterone groups. It is likely that the analgesic effect of NSAIDs on the estrogen group was unremarkable compared to those of the placebo and progesterone groups because of the antinociceptive action of estrogen.

Electrophysiological study on the modulation of uterine mechanoreceptor by substance P / 대한산부인과학회잡지

OBJECTIVE: In inflammation, hyperalgesia is a common phenomenon but its mechanism has not been clarified. Recently some reports suggested substance P might be important factors for inflammatory hyperalgesia in somatic tissue. This study was performed to see whether substance P modulate the activities of uterine afferent fibers in the hypogastric nerve of the cat. METHODS: While recording the electrical activities of nerve fibers, mechanical stimuli were applied as balloon distention using balloon inserted into uterine lumen before and during substance P infusion through uterine artery. RESULTS: Substance P increased the responses to balloon distension of uterus in 14 uterine mechanoreceptive afferent fibers of 24 over 10% compared to before substance P infusion, and decreased the responses of 3. And L-703,606, the neurokinin 1 receptor antagonist failed the modulation of mechano sensitive response by substance P and reduced the spontaneous activities. CONCLUSIONS: These results suggest that substance P modulated the activities of uterine nerve fibers and their responses to mechanical stimulus. It is hypothesized that this kind of modulation of afferent nerve fibers by substance P may be important for the development of inflammatory hyperalgesia.

Effects of Norepinephrine on the Mechanoreceptors of the Urinary Bladder in the Cat / 대한마취과학회지

BACKGROUND: Recent findings suggest that a coupling between the somatic and sympathetic nervous system is critical not only for the development but also for the maintenance of pain behavioral changes. However, studies on the effect of sympathetic efferent system on sensory receptors in the visceral organ that is more dependent on the autonomic nervous system are lacking. This study examined whether norepinephrine (NE) had an influence on the mechanoreceptors in the feline urinary bladder. METHODS: Ten adult male cats were used and anesthetized with alpha-chloralose and artificially ventilated. A cannula with the pressure transducer was inserted through the urethra to apply mechanical stimuli and monitor the pressure of bladder. A tiny cannula inserted into the bilateral side branches of vesical arteries were used as a route for a NE (10A.M 9:40 01-10-08 bilaterally) injection. Nerve fiber recordings were obtained from the distal stump of the pelvic nerve. RESULTS: After the NE injection, the response of mechanoreceptors (n = 13) to the isotonic pressure stimulus (50 - 60 mmHg) decreased significantly (p < 0.05) in terms of sensitivity (i.e., ratio of nerve activity change to urinary bladder pressure change). The responses to pressure stimuli after an injection of an alpha1 adrenoceptor blocker (terazosin) reversed the effect of NE. The responses of mechanoreceptors to isotonic pressure stimulus were not affected significantly by NE with preinjection of an alpha2 adrenoceptor blocker (yohimbine). CONCLUSIONS: These results suggest that NE may have influence on the sensitivity of mechanoreceptors in the normal feline urinary bladder via an alpha1 adrenoceptor.

Alterations in substance P and CGRP immunoreactivities in the uterus following the induction of inflammation in the rats / 대한산부인과학회잡지

OBJECTIVE: Recently some reports suggested substance P and CGRP might be important factors for inflammation and hyperalgesia. This study was performed to see whether substance P or CGRP containing nerve fibers might be changed by mustard oil-induced inflammation. METHODS: After injection of mustard oil(5%) into uterine lumen, the uteri were removed and examined with immunohistochemical methods for substance P and CGRP. RESULTS: In the normal uterus, most of the substance P- or CGRP-immunoreactive nerve fibers were observed along the vascular structure and some in the myometrium, only few in the endometrium. Mustard oil did not changed this pattern of nerve fiber distribution but after 48 hrs, the amount of substance P or CGRP immunoreactive nerve fibers were greatly reduced compared with the normal uterus. It is not clear whether the decrease of substance P and CGRP immunoreactive fibers in the uterus was resulted from the depletion of the neuropeptides in the nerve fibers or the retraction of nerve fibers. CONCLUSIONS: These results suggest that the inflammation should cause the change of nerve fibers included in the nociception. This change may attribute the generation of inflammation and inflammatory hyperalgesia.

Analgesic and Anti-inflammatory Effects of Ibuprofen, Indomethacin and NS-398 on an Acute Model of Arthritis in Rats / 대한마취과학회지

BACKGROUND: All currently available nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit both cyclooxygenase-1 and cyclooxygenase-2 and exhibit many complications. It has been suggested that the anti-inflammatory and also most of the analgesic effects of NSAlDs result from an inhibition of arachidonic acid metabolites synthesised via cyclooxygenase-2. In the present study, the extent of analgesic and anti-inflammatory effects of ibuprofen (a non-selective cyclooxygenase inhibitor), indomethacin (a selective cyclooxygenase-1 inhibitor) and NS-398 (a selective cyclooxygenase-2 inhibitor) are investigated in on acute model of arthritis in rats by a behavior test and pathologic examination. METHODS: Arthritis was induced with 2% kaolin and 3% carrageenan into the right knee joint cavity under enflurane anesthesia (2 - 4%). Before and after the injection, rats were allowed to walk freely through a pathway, constructed to record weight load by means of 8 weight sensors attached to 8 plates which function independently. Weight bearing, the weight of rat and the diameter of the knee joint were measured serially before and after the injection. At 6 hours after the injection, ibuprofen, indomethacin and NS-398 were injected intraperitoneally (1, 5 and 25 mg/kg/ml). RESULTS: In the control group, weight bearing decreased maximally and the weight bearing ratio increased maximally at 6 hours after inflammation and the diameter ratio increased maximally 1 day after inflammation. There were improvements in weight bearing with ibuprofen, indomethacin and NS-398 in a dose-dependent manner at 8, 10 and 12 hours after induction of arthritis. NS-398 demonstrated better analgesic and anti-inflammatory effects than ibuprofen or indomethacin at a low dose (1 mg/kg). In contrast to NS-398, significant analgesic effects of indomethacin on the behavior test was not shown at a low dose. CONCLUSIONS: These results suggest that the selective cyclooxygenase-2 inhibitor plays an important role as an analgesic and anti-inflammatory drug.

Increased response of hypogastric nerve fibers to bradykinin by mustard oil-induced uterine inflammation in the rat

It is well known that the inflammation of somatic tissues, bladder and colon can alter the sensitivity of primary afferents innervating these tissues. To see if uterine afferents also show altered sensitivity, we examined their responses to the algesic agent bradykinin before and after induction of uterine inflammation. Inflammation was induced by injecting the mustard oil into the uterine lumen of adult female rats. After induction of inflammation, the response latency to bradykinin did not change, but the duration and peak of the response and integrated impulse discharges during the response period increased significantly. Furthermore, after inflammation, the level of resting discharges of the afferents was much higher. These results are consistent with the idea that the inflammation can sensitize the uterine afferents.

Effect of knee joint stimulation on the activity of phrenic nerve and inspiratory nuron in the cat / 결핵

No abstract available.