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Each country is providing various community care services owing to the increasingly aging population. Therefore, Korea needs to develop multiple approaches to the healthcare utilization system that can reflect the complex needs of older adult patients.Current Concepts: Considering the characteristics of older adult patients, it is essential to connect the treatment at medical institutions with home or nursing facilities. Some patients need medical and long-term healthcare simultaneously. Currently, healthcare services for older adult patients in Korea are fragmented across various service areas. Therefore, healthcare service plans need to be explored to provide integrated and long-term healthcare for older adult patients.Discussion and Conclusion: We propose to establish a healthcare information linkage center to provide comprehensive information on the appropriate services needed by patients. The healthcare information linkage center would refer patients to their local community or local primary healthcare provider if they want home services. Through this process, doctors and healthcare teams would visit the patient’s residence to provide services and perform a comprehensive assessment of their condition to create a personalized care plan. The core of this proposal lies in the establishment of a single point of contact in the region to link and integrate healthcare. Consequently, information on services appropriate to the needs of the target population would be appropriately linked in one place and overlapping services would be coordinated to improve operational efficiency.
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Background@#The purpose of this study is to analyze the differences in the acceptability of telemedicine between telemedicine-experienced and -inexperienced physicians. @*Methods@#A questionnaire survey was conducted using the Doctor Survey of the Korean Medical Association. A total of 1,385 physicians were included in the analysis. Propensity score matching was used to control selection bias. The chi-square tests were used for bivariate analysis. Multiple logistic regression analysis and multinomial logistic regression analysis were used to adjust for covariates (gender, age, working area, working type, institution type, and the specialty of physicians). @*Results@#Physicians with experience in telemedicine were 2.53 times more likely to accept to allow telemedicine as a medical system than physicians without experience in telemedicine. Physicians with experience in telemedicine responded that telemedicine should be allowed to returning patients only and not be allowed to first-time patients. This response of telemedicine-experienced physicians was 3.73 times higher than that of telemedicineinexperienced physicians. Physicians with experience in telemedicine responded that telemedicine for first-time patients should be only allowed under specific situations. This response of telemedicine-experienced physicians was 2.59 times higher than that of telemedicine-inexperienced physicians. @*Conclusion@#Telemedicine-inexperienced physicians were more acceptable to telemedicine as a medical system than telemedicine-inexperienced physicians. Physicians with experience in telemedicine suggested that telemedicine should be allowed to returning patients only and might be allowed to first-time patients only under specific situations.
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Background@#Many countries need help with the problem of an unbalanced distribution of physicians and hospitals. Moreover, various policies and strategies have been proposed to solve this problem. This study aimed to examine the determinants of the unbalanced distribution of physicians. @*Methods@#From the 2020 Korean Physician Survey data, 4,181 physicians practicing in Korea were limited to the subjects of the study. We analyzed the factors influencing physicians’ choice of practice location and their willingness to change their practice location from an urban to a rural area. @*Results@#The region of physicians’ hometown, medical school, and residency training hospitals determined their choice of practice location. The type of affiliated healthcare organization and the location of physicians’ hometown, medical school, and residency training hospitals affected their willingness to change their practice location from an urban to a rural area. Furthermore, the concordance rate of the regions of physicians’ hometown, medical school, and residency training hospitals with the region of their practice location was 24.9%. @*Conclusion@#In South Korea, policies for doctors have been designed without considering why they are reluctant to work in rural hospitals. To have a balanced distribution of physicians and hospitals, it is necessary to accurately analyze the status of medical resources based on regions and identify the current and future medical demand. The social situation, such as future demographic change and regional extinction, must also be fully considered. Furthermore, policies should be implemented that encourage physicians to work in rural hospitals.
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Background@#To suggest measures to prevent burnout of physicians during the coronavirus disease 2019 (COVID-19) pandemic, we conducted a systematic review of research on physician burnout due to COVID-19. @*Methods@#Three foreign databases were used: MEDLINE, Embase, and the Cochrane Library. A search was performed using the following search terms: COVID-19, coronavirus, NCOV, physicians, doctors, residents, and burnout. Four rounds of review were performed to enhance the consistency of quality assessment. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to assess the quality of the eligible studies. @*Results@#A total of 465 studies were identified, of which 32 were selected. The quality assessment determined that 19 studies met the Joanna Briggs Institute criteria and had a low risk of bias. The most common tool used to measure physician burnout in the 32 studies was the Maslach Burnout Inventory. @*Conclusion@#This study systematically evaluated the literature on physician burnout. However, the generalizability of our findings to Korean physicians may be limited. The composition of the medical personnel in Korea, such as open doctors, volunteer doctors, medical professors, and public health doctors, differs significantly from that of other countries. Nevertheless, evaluating the current status of physician burnout due to COVID-19 globally may hold meaningful implications for policymaking.
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Background@#To suggest measures to prevent burnout of physicians during the coronavirus disease 2019 (COVID-19) pandemic, we conducted a systematic review of research on physician burnout due to COVID-19. @*Methods@#Three foreign databases were used: MEDLINE, Embase, and the Cochrane Library. A search was performed using the following search terms: COVID-19, coronavirus, NCOV, physicians, doctors, residents, and burnout. Four rounds of review were performed to enhance the consistency of quality assessment. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to assess the quality of the eligible studies. @*Results@#A total of 465 studies were identified, of which 32 were selected. The quality assessment determined that 19 studies met the Joanna Briggs Institute criteria and had a low risk of bias. The most common tool used to measure physician burnout in the 32 studies was the Maslach Burnout Inventory. @*Conclusion@#This study systematically evaluated the literature on physician burnout. However, the generalizability of our findings to Korean physicians may be limited. The composition of the medical personnel in Korea, such as open doctors, volunteer doctors, medical professors, and public health doctors, differs significantly from that of other countries. Nevertheless, evaluating the current status of physician burnout due to COVID-19 globally may hold meaningful implications for policymaking.
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Since the last 100 years, physicians from many countries have been taking collective action. However, the media, civic groups, and the government have denounced them as inhuman and unethical. This study comprehensively analyzed the background and results of physicians’ collective actions that occurred in countries around the world, and reviewed the issues surrounding them. Among 314 cases in 70 countries discussed in the literature, 180 cases in 65 countries were analyzed. Of these 180 cases, 111 (61.7%) were successful, indicating that collective action has brought favorable results to physicians. Furthermore, 177 out of 301 requirements brought favorable results (58.8%). The main reason for collective actions was ‘improvement of working conditions’, which includes improving the medical and the reimbursement systems, adjusting working hours and wages, increasing manpower, supporting medical research, and improving other working environment and conditions. This study is significant because it provides statistical data on the causes and results of collective actions taken by physicians in countries around the world.
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Background/Aims@#To improve the eradication rate of a first-line therapy for Helicobacter pylori infection, alternate regimens such as sequential, concomitant, and hybrid therapies have been tried. The aim of this study was to evaluate the eradication rate of the 10-day hybrid therapy as a first-line therapy. @*Materials and Methods@#This retrospective study enrolled 124 patients from the Korea University Ansan Hospital between April 2016 and December 2019. The 10-day hybrid therapy comprised 5 days of dual therapy (proton pump inhibitor [PPI] standard dose and amoxicillin 1 g, twice daily) followed by 5 days of quadruple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, twice daily). We compared the 10-day hybrid therapy with the 10-day concomitant therapy comprising PPI, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, twice daily. Eradication was assessed by a 13C-urea breath test or gastroscopic biopsy at least 4 weeks after treatment completion. @*Results@#The eradication rates of the 10-day hybrid and concomitant therapies were 74.2% (46/62) and 67.7% (42/62), respectively, in the intention-to-treat (ITT) analysis and 88.5% (46/52) and 82.4% (42/51), respectively, in the per-protocol (PP) analysis. There was no significant difference in the eradication rates between the two groups in the ITT (P=0.429) and PP analysis (P=0.380). Adverse events developed in 75.0% and 70.6% of patients in the hybrid and concomitant groups, respectively, but there was no significant difference (P=0.615). @*Conclusions@#The 10-day hybrid therapy can be an option for a first-line therapy of Helicobacter pylori infection.
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The government argues that the expansion of the number of physicians is inevitable due to the absolute lack of practising physicians in Korea compared to members of the Organisation for Economic Co-operation and Development. Further, the government contends that poor medical access and adverse effects on the national health level require such an expansion. This study aimed to verify whether the government’s claims regarding the lack of physician manpower are reasonable by estimating the projected supply and demand of physicians by 2023 based on scenarios involving their productivity and number of working days. As a result, all scenarios indicated a projected oversupply, except for the scenario in which there are 255 working days and physicians’ productivity is the same as that of 2018. Even in scenario three, in which there are 255 working days and physicians’ productivity is the same as that of 2018, an oversupply was projected from 2027. Standards regarding the number of physicians vary from country to country, as they are affected by various factors including medical systems, demographic structures, national health levels, medical infrastructures, accessibility, medical finance and geographical conditions. This issue can be seen as resulting from the unbalanced regional distribution of physicians rather than from an absolute shortage of the number of physicians. The trickle-down effect of expanding the medical student enrollment cannot solve the problem of the unbalanced regional distribution of physicians.
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As the world is facing an infectious disease pandemic caused by coronavirus disease 2019 (COVID-19), medical institutions are experiencing significant financial losses. we attempted to estimate such financial losses through a survey of clinics that reported temporary closure due to COVID-19 to the Korean Medical Association. As a result, the data of 56 clinics were obtained. The average closure period was 6.7 days, and the overall number of related health insurance claims and loss of sales reached 13,408,000 Korean won (KRW) and 20,911,000 KRW, respectively, while daily losses reached 1,343,000 and 2,202,000 KRW, respectively. In addition, the monthly average health insurance claims and sales were compared to those of the same month of the previous year. In January, they slightly increased by 4.4% and 7.8%, respectively, whereas in February, they slightly decreased by 10.2% and 12.4%, respectively. In March, they significantly decreased by 46.8% and 49.8%, respectively, as COVID-19 was at its peak. Considering the financial losses of clinics that played a pivotal role in quarantine at the forefront of infectious diseases, the government should prepare a reasonable compensation plan for such losses.
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Background/Aims@#To improve the eradication rate of a first-line therapy for Helicobacter pylori infection, alternate regimens such as sequential, concomitant, and hybrid therapies have been tried. The aim of this study was to evaluate the eradication rate of the 10-day hybrid therapy as a first-line therapy. @*Materials and Methods@#This retrospective study enrolled 124 patients from the Korea University Ansan Hospital between April 2016 and December 2019. The 10-day hybrid therapy comprised 5 days of dual therapy (proton pump inhibitor [PPI] standard dose and amoxicillin 1 g, twice daily) followed by 5 days of quadruple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, twice daily). We compared the 10-day hybrid therapy with the 10-day concomitant therapy comprising PPI, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg, twice daily. Eradication was assessed by a 13C-urea breath test or gastroscopic biopsy at least 4 weeks after treatment completion. @*Results@#The eradication rates of the 10-day hybrid and concomitant therapies were 74.2% (46/62) and 67.7% (42/62), respectively, in the intention-to-treat (ITT) analysis and 88.5% (46/52) and 82.4% (42/51), respectively, in the per-protocol (PP) analysis. There was no significant difference in the eradication rates between the two groups in the ITT (P=0.429) and PP analysis (P=0.380). Adverse events developed in 75.0% and 70.6% of patients in the hybrid and concomitant groups, respectively, but there was no significant difference (P=0.615). @*Conclusions@#The 10-day hybrid therapy can be an option for a first-line therapy of Helicobacter pylori infection.
ABSTRACT
The government argues that the expansion of the number of physicians is inevitable due to the absolute lack of practising physicians in Korea compared to members of the Organisation for Economic Co-operation and Development. Further, the government contends that poor medical access and adverse effects on the national health level require such an expansion. This study aimed to verify whether the government’s claims regarding the lack of physician manpower are reasonable by estimating the projected supply and demand of physicians by 2023 based on scenarios involving their productivity and number of working days. As a result, all scenarios indicated a projected oversupply, except for the scenario in which there are 255 working days and physicians’ productivity is the same as that of 2018. Even in scenario three, in which there are 255 working days and physicians’ productivity is the same as that of 2018, an oversupply was projected from 2027. Standards regarding the number of physicians vary from country to country, as they are affected by various factors including medical systems, demographic structures, national health levels, medical infrastructures, accessibility, medical finance and geographical conditions. This issue can be seen as resulting from the unbalanced regional distribution of physicians rather than from an absolute shortage of the number of physicians. The trickle-down effect of expanding the medical student enrollment cannot solve the problem of the unbalanced regional distribution of physicians.
ABSTRACT
As the world is facing an infectious disease pandemic caused by coronavirus disease 2019 (COVID-19), medical institutions are experiencing significant financial losses. we attempted to estimate such financial losses through a survey of clinics that reported temporary closure due to COVID-19 to the Korean Medical Association. As a result, the data of 56 clinics were obtained. The average closure period was 6.7 days, and the overall number of related health insurance claims and loss of sales reached 13,408,000 Korean won (KRW) and 20,911,000 KRW, respectively, while daily losses reached 1,343,000 and 2,202,000 KRW, respectively. In addition, the monthly average health insurance claims and sales were compared to those of the same month of the previous year. In January, they slightly increased by 4.4% and 7.8%, respectively, whereas in February, they slightly decreased by 10.2% and 12.4%, respectively. In March, they significantly decreased by 46.8% and 49.8%, respectively, as COVID-19 was at its peak. Considering the financial losses of clinics that played a pivotal role in quarantine at the forefront of infectious diseases, the government should prepare a reasonable compensation plan for such losses.
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Purpose@#The purpose of this study is to develop and evaluate the curriculum, that was the continuing professional development program, for cultivating physician’s competencies in public health. @*Methods@#This study was conducted through in-depth interview and survey in the frame of ADDIE, from 2 May to 30 June in 2019. Participants were 7 physicians by in-depth interview and Respondents were 46 physicians worked in public health by survey. @*Results@#The results were analyzed and described in the frame of ADDIE model. In the stage of Analysis, physician’s core competencies in public health was presented to practical education, management of organization and labor force, communication with community, and director’ role of public health center in the community as core competencies by in-depth interview. The skill–knowledge-attitude competencies were highest in order in the survey for placing priority (by Borich score) of 29 core competencies. In design stage, the educational objective of curriculum was established, that is to develop the competencies of knowledge, skills, and attitude needed for physician of public health in 21th century. In development and implementation stage, it is important to decide to lecturer, to get in advance educational materials to do the maintenance and management of curriculum. In the stage of evaluation, the educational satisfaction was high on the whole and educational effect was statistically significant. @*Conclusions@#This study was an initial study of Korean doctors, and it aims to pursue competency-based education as a continuing professional development (CPD) beyond continuing medical education (CME) including knowledge, skills, and attitudes.
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Three-dimensional (3D) tissue/organ printing is a major aspect of recent innovation in the field of tissue engineering and regenerative medicine. 3D tissue/organ printing aims to create 3D living tissue/organ analogues, and have evolved along with advances in 3D printing techniques. A diverse range of computer-aided 3D printing techniques have been applied to dispose living cells together with biomaterials and supporting biochemical factors within pre-designed 3D tissue/organ analogues. Recent developments in printable biomaterials, such as decellularized extracellular matrix bio-inks have enabled improvements in the functionality of the resulting 3D tissue/organ analogues. Here, we provide an overview of the 3D printing techniques and biomaterials that have been used, including the development of 3D tissue/organ analogues. In addition, in vitro models are described, and future perspectives in 3D tissue/organ printing are identified.
Subject(s)
Biocompatible Materials , Extracellular Matrix , In Vitro Techniques , Printing, Three-Dimensional , Regenerative Medicine , Tissue EngineeringABSTRACT
Eosinophilic pustular folliculitis(EPF) is characterized by recurrent crops of pruritic follicular papules and pustules that occur mainly on the face, trunk, and extremities of young men. EPF in infancy is a rare disorder which reveals the distinctive clinical features consisting of self-limited recurrent papules, pustules, and vesicles appearing in corps, involving mainly or exclusively the scalp. We describe two patients with EPF in infancy. Both patients had self-limited recurrent crops of papules and pustules affecting the scalp only.
Subject(s)
Humans , Male , Eosinophils , Extremities , Folliculitis , ScalpABSTRACT
BACKGROUND: The factors that regulate hair follicle growth are still poorly understood. In vitro models may be useful in elucidating some aspects of hair follicle biology. TNF-alpha is potent inhibitor of hair follicle growth. TNF-alpha induces the formation of a club-like hair follicle, similar to catagen morphology of the hair bulb. Minoxidil induces generalized hypertrichosis when administered systemically, or localized hair regrowth when applied topically to sites of alopecia. OBJECTIVE: The purpose of this study is to investigate the effect of TNF-alpha and minoxidil on human hair growth using in vitro model. METHODS: Healthy human hair follicles without any visible damage were collected, they were cultured in Williams E medium with several combinations of supplements and TNF-alpha and/or minoxidil were added to the media. The results were evaluated by measuring linear hair fiber growth and hair follicle morphology on light microsocopy and by measuring radioisotope uptake of (methyl-3H)thymidine of hair follicle. RESULTS: The following results were obtained from this study. TNF-alpha have inhibitory effect on the rate of linear hair growth in cultured hair follicles. Minoxidil has no stimulatory effect on the rate of linear hair growth and no protective effect on the TNF-alpha induced growth inhibition in cultured hair follicles. CONCLUSION: TNF-alpha has growth-inhibitory effect and minoxidil has no protective effect on the TNF-alpha induced hair change.
Subject(s)
Humans , Alopecia , Biology , Hair Follicle , Hair , Hypertrichosis , Minoxidil , Tumor Necrosis Factor-alphaABSTRACT
Transient acantholytic dermatosis was first described by Grover in 1970. It is characterized by pruritic, discrete papules and papulovesicles distributed mainly on the trunk. The histologic hallmark of the disorder is focal acantholysis, several patterns of which have been described. The etiologic factors and pathogenesis remain unclear. We report a 45-year-old male patient with multiple severely pruritic, discrete papules and papulovesicles on the trunk. There were no oral cavity, palm and sole involvement. Histopathologic findings revealed epidermal acanthosis, acantholysis and hyperkeratosis with suprabasal splits. He showed good response to topical steroid and oral antihistamine.
Subject(s)
Humans , Male , Middle Aged , Acantholysis , Mouth , Skin DiseasesABSTRACT
BACKGROUND: Periungual warts are a therapeutic challenge. Many studies have revealed that intralesional interferon α-2b therapy and pulsed dye laser therapy have numerous advantages over other modalities of theratment. OBJECTIVE: The purpose of this study was to determine if combination therapy with intralesional interferon α-2b and pulsed dye laser might offer an effective treatment for periungual warts. METHODS: Thirty-three patients were randomly assigned to one of three study groups. In group A, the patients received both intralesional interferon α-2b treatment and pulsed dye laser(PDL) therapy (n=13). Group B patients were treated wit intralesional interferon α-2b alone (n=10) and group C was done with PDL therapy only (n=10). RESULTS: The clearance rate was 92.3% for the patients treated with the combination therapy of intralesional interferon α-2b treatment and pulsed dye laser (PDL) therapy. It was 50% for the patients with the intralesional interferon α-2b treatment alone, and 0% for the group with the PDL therpy only. No significant side effects were observed. At 6 months after cessation of the therapy, total 2 cases (one from group A and the other from group B) were recurred. CONCLUSION: The combination therapy with intralesional interferon α-2b treatment and pulsed dye laser therapy was highly effective for the treatment of recalcitrant periungual warts.
Subject(s)
Humans , Interferons , Lasers, Dye , WartsABSTRACT
Calcifying aponeurotic fibroma is a rare benign soft tissue tumor that primarily occurs in children and adolescents and has a strong predilection for the distal portion of the extremities and has a tendency to recur. A case of calcifying aponeurotic fibroma arising in the tip of 2nd digit of right hand of 24-year-old woman was presented. The lesion was solitary, 0.5X0.5cm sized, mildly tender, erythematous papule. Microscopic finding showed poorly circumscribed proliferation of dense fibrous tissue containing epihelioid-like fibroblasts, islands of metaplastic chondroid differentiation with focal calcification.
Subject(s)
Adolescent , Child , Female , Humans , Young Adult , Extremities , Fibroblasts , Fibroma , Hand , IslandsABSTRACT
Pleomorphic adenomas mostly occur in major salivary glands. Pleomorphic adenomas arising in the external auditory canal are very rare. The clinical features and natural history of patients with this tumor are obscure. The patients with pleomorphic adenoma of the external auditory canal mostly complain of painless lump, otorrhea, ear fullness and hearing loss. Treatment of choice is a wide excision of tumor to prevent local recurrence. We experienced a case of pleomorphic adenoma in the external auditory canal causing ear fullness and mild otalgia which was treated by local excision via endaural approach. The patient has been free of disease for about 14 months after the treatment. We report the case with a review of literatures.