Professional Job Perception, Job Stress and Job Satisfaction of Westerm Doctors and Oriental Doctors Practicing at Local Clinic / 예방의학회지

OBJECTIVE: This study was conducted in order to investigate the professionalism, job stress and job satisfaction in western and oriental doctors in Korea. METHODS: The authors conducted a survey using a selfadministered questionnaire, conducted between August and September, 2001. The study subjects were 457 western doctors and 161 oriental doctors practicing at local clinics in Daegu City. RESULTS: For the professionalism scale, the score for 'belief in service to the public' of western doctors was significantly higher than that of oriental doctors (p< 0.05) whereas the scores for 'sense of calling to the field' and 'feeling of autonomy' were higher in oriental doctors (p< 0.01). For the job stress scale, the scores for 'work factor', and 'clinical responsibility/decision factor' of western doctors were significantly higher than those of oriental doctors (p< 0.01). Of the western doctors, 59.7% expressed satisfaction with their job as a doctor, 69.5% responded that the role of a doctor was appropriate to their aptitude, and 61.8% answered that they wouldn't consider other kinds of job even if offered. In case of oriental doctors, these responses were83.1%, 82.5%, and 82.3%, espectively. CONCLUSION: The job stress scores of western doctors were higher than those of oriental doctors, but the job satisfaction was lower. The reasons for the above results are not clear. Further studies are required to understand the characteristics of job stress and job satisfaction in doctors.

Professional Job Perception, Job Stress and Job Satisfaction of Doctors Practicing in Local Clinic in Daegu City / 예방의학회지

OBJECTIVE: This study was conducted in order to investigate professional job perception, job stress and job satisfaction in doctors. METHOD: The authors conducted a survey using a self-administered questionnaire, conducted between August and September, 2001. The study subjects were 457 doctors practicing at local clinics in Daegu City. RESULTS: For the professionalism scale, the score for 'sense of calling to field' and 'feeling of autonomy' were relatively high. Age, working hours per day, and perception of socioeconomic status significantly influenced the professionalism scale scores (p 2.0). The working hours per day and status perception also influenced their job satisfaction (T> 2.0). CONCLUSION: To promote the job satisfaction of doctors, the development of coping tools and other intervention methods are needed to increase doctor's professional job perception and reduce their job stress. Further studies are required to understand the characteristics of job satisfaction and for its promotion with doctors.

The Clinical Use of Various Nasal Implants in Rhinoplasty

From an aesthetic surgical point of view, rhinoplasty is one of most important field. The nose of asian is characterized by thin and weak nasal septal cartilage, wide and small alar cartilage, bulbous nasal tip due to excessive fibrous tissue and thick skin. Conventional rhinoplasty is not enough to get a satisfactory result. In order to produce optimal nasal shape, it is extremely important to augment the tip along with nasal dorsum in most of the patients. From March of 1997 to June of 1999, total 162 patient underwent open rhinoplasty with various nasal implants. Surgical approach was done through the transcolumella incision and alar rim incision. The nasal dorsum was augmented with silicone implant, and columella shape was controlled by 0.85-mm thickness porous high-density polyethylene sheet(Medpor). Porous high-density polyethylene sheet was 4mm width and was placed between the medial crura. The nasal tip was corrected by Polytetrafluoroethylene(Gore-Tex) implant. Reverse pyramidal shaped onlay graft of Polytetrafluoroethylene(Gore-Tex"") implant was not palpable on nasal tip skin. We obtained harmonious nasal shape and high patient satisfaction. There was two infection and one exposure of Polytetra- fluoroethylene(Gore-Tex) implant, but there was no other major complications. We believe that this method is stable, reliable, predictable, valuable technique for rhinoplasty, but we think that further follow up and study are needed.

The Effect of Topical Application of Capsaicin on the Flap Survival

Capsaicin is the principal pungent component of Capsicum fruits. Biological effect of capsaicin is various and complicated. This study was undertaken to define the effect of topical application of capsaicin on flap survival in rat. Fourty Sprague Dawley rats were divided into four groups. With ten rats in each group, group A was only flap elevation group, as the control, group B was applied 0.025% capsaicin ointment for 7 days after skin flap elevation, group C was applied 0.075% capsaicin ointment for 7 days after skin flap elevation, group D was elevated two skin flap and one flap was control, the other flap was applied 0.075% capsaicin ointment for 7 days. Group A demonstrate 46.2+ 2.5% flap survival rate. Group B demonstrate 48.8+/-7.8% of flap survival rate, group C demonstrate 53.3+/-7.0% of flap survival rate. Control flap on group D demonstrate 43.5+/-3.5% of flap survival rate, 0.075% capsaicin applied flap demonstrate 52.9+/-7.2% of flap survival rate. Compared to the control group, increase in survival rate in group B was not statistically significant. The mean flap survival rate in group C was significantly increased than control group (p < 0.05). Compared to the control flap in group D, 0.075% capsaicin applied flap showed significantly higher flap survival rate. Based upon this data, local application of 0.075% capsaicin ointment demonstrate significantly increased value of survival area and survival rate on skin flap in rat (p < 0.05). And further studies may be needed for the evaluation of correct action mechanisms of capsaicin.

Reconstruction of the defects with free flaps after head and neck cancer ablation

The number of cancers in the head and neck areas has been increasing due to the increasing life span of the patients and a free flap is a common procedure to reconstruct defect in the head and neck area. From March 1990 to February 1998, 105 patients underwent 110 free flap operations after head and neck cancer ablation and they were reviewed retrospectively. Among 110 free flaps, 93 are forearm flaps, 6 jejunal flaps, 5 vascularized fibular osteocutaneous flaps, 2 lateral arm flaps, 2 rectus abdominis myocutaneous flaps and 1 latissimus dorsi muscle flap and 1 latissimus dorsi myocutaneous flap. Sixty-five radial forearm flaps and 4 ulnar forearm flaps were utilized in patched type and 24 radial forearm flaps in tubed type mainly for the reconstruction of intraoral and hypopharyngeal defects. Sis jejunal flaps were utilized for the esophageal reconstruction and 5 vascularized fibular osteocutaneous flaps for the mandibular reconstruction. The remaining flaps were for the reconstruction of other areas of head and neck.Overall survival rate of the flap was 95.5%. Immediate complications were fistula formation(3 cases), total flap loss (4 cases) or partial flap loss(3 cases) and donor site problems(10 cases). Superior thyrodial artery was the most commonly used recipient artery(89 cases) which was followed by facial artery, lingual artery and transverse cervical artery. Size discrepancy was not remarkable between the donor and recipient arteries. However, there was usually a marked size discrepancy between donor and recipient veins. More than two venous anastomoses were performed to increase the success rate of the flap surgery. An average follow-up period was 38 months ranging from 3 months to 6 years. There was no patient who died during or right after the operations, but 23 patients died due to recurrence of tumors or underlying heart disease during the follow-up period. Remaining patients lived well excluding 6 late postoperative complications such as 4 cases of esophageal stenosis and 2 cases of osteoradionecrosis. We conclude that free flap reconstruction after head and neck cancer ablation improves the quality of life and minimizes the loss of function.

Treatment of osteonecrosis of the femoral head with free vascularized fibula transfer

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.