What affects the job satisfaction of emergency physicians? Based on the 2020 Korean Emergency Physician Survey

Objective@#This study aimed to find changes in the job satisfaction of emergency physicians (EP) and suggest ways to objectively measure indicators of satisfaction for future surveys. @*Methods@#A total of 2,138 emergency physicians were surveyed, using email questionnaires from January to February of 2021. The factors related to their job satisfaction were analyzed. @*Results@#Emergency physicians’ satisfaction was low. The average number of times they experienced violence per year was 4.3±4.9 per year. Work intensity and salary satisfaction improved than those in the 2010, and 2015 Korean Emergency Physician Survey (KEPS). Health status, such as drowsiness, and depression rates, were low. Forty-three percentage of EPs said they would reapply for the emergency specialty. @*Conclusion@#Despite the increase in extrinsic indicators, job satisfaction remained low compared to those in the 2010, and 2015 KEPS. To improve job satisfaction, non-quantitative factors should be considered. It would be necessary to evolve a separate survey on job satisfaction and conduct regular surveys in this regard.

Analysis of emergency residents health status and affected factors by 2019 Korean Emergency Medicine Resident Survey (KEMRS)

Objective@#Emergency medicine residents are expected to exhibit a poor health status due to excessive working hours and high stress. Because much of patient care depends on them, their health conditions will have a significant impact on patient outcomes. Our study was designed to analyze the health status of emergency medicine residents and the affecting factors using the 2019 Korean Emergency Medicine Residents Survey (KEMRS) results. @*Methods@#The study evaluated the self-rated health-defined percentage of responders who thought they were in good health. Based on this response, the influencing factors were categorized statistically. These factors included personal characteristics, lifestyle (drinking, smoking, eating, sleeping, and exercise), and emotional stress. @*Results@#Of a total of 384 respondents, 176 (46%) thought they were in good health. Participants who perceived themselves to be unhealthy included residents who were married, female, and those in the 3rd grade. Drinking and smoking were not perceived to affect health status, but regular exercise and proper eating patterns were seen to be positive influencing factors. Daytime sleepiness, depressive moods, and personal well-being were correlated with health status. @*Conclusion@#While personal characteristics and emotional problems cannot be changed easily, lifestyle changes can be made for better health. The health conditions of emergency residents have not been considered a matter of importance thus far. To overcome their health problems, responsible improvements in schedules and a program of long-term follow-ups need to be implemented, followed by training programs.

Emergency medicine residents’ needs assessment for education and training using nationwide survey

Objective@#This study was conducted to identify the needs assessment for education and training of emergency medicine (EM) residents. @*Methods@#The results of a national survey of EM residents of the Korean Society of Emergency Medicine in 2019 were used. Education was one of the five categories in the survey. The preferred learning methods and their perceived importance and ability to perform in nine competencies were assessed. The Borich’s needs assessment model was used to analyze their needs. @*Results@#Among 591 EM residents, 382 responded, and 371 responses were finally analyzed. Regarding the learning methods, junior residents preferred in-hospital conferences, staff lectures, internet resources, and textbooks. Overall, medical knowledge and procedural skills were the most important, and research was less important to recognize. Medical knowledge showed the highest rank in the needs assessment in all years, and ethics and professionalism showed the lowest ranks. The needs for procedural skills were higher in junior years but lower in senior years. @*Conclusion@#These results will form the basis for the design of training programs to meet the educational needs of EM residents for each grade. Furthermore, an analysis of the educational needs should be done periodically according to the changes and demands of the times.

3-h drain clamping is not effective to reduce total blood loss after primary total knowledge

Purpose@#Total knee arthroplasty (TKA) is a clinically efficacious surgical option for end-stage knee osteoarthritis.However, TKA increases the risk of serious bleeding and blood transfusion. The objective of this study was to evaluate the difference in postoperative blood loss in groups subjected to 3 h of clamping and non-clamping and determine the variations in rate and amount of transfusion after TKA between the two groups. @*Materials and methods@#Propensity score matching of the group subjected to 3-h drain clamping (43 patients;September 2015 to April 2016) and the control group (43 patients; before initiating the clamping method) was performed in patients undergoing unilateral primary posterior stabilized TKA. The two groups were compared. We measured the total drained blood volume until the drain was removed 48 h after surgery, and we compared the preoperative levels of hemoglobin and hematocrit with levels observed on days 1 and 2 after surgery. We also determined the blood transfusion rate and volume as well as the occurrence of clamping-associated complications. @*Results@#In the group subjected to 3-h drain clamping, the mean volume of total drained blood was significantly lower than in the control group (333.8 ± 190.2 mL vs. 839.9 ± 339.8 mL, P <0.001). There was no significant difference in total blood loss between the two groups (1226.9 ± 488.1 mL vs. 1127.1 ± 424.5 mL,P = 0.315), but the hidden blood loss was significantly higher in the 3-h drain clamping group than in the control group (893.1 ± 487.7 mL vs.294.7 ± 531.8 mL, P <0.001). Both the transfusion rate and amount in the 3-h drain clamped group were higher than in the control group but were not statistically significant (30.2% vs. 37.2%, P = 0.494 and 269.8 ± 483.8 mL vs.316.3 ± 158.2 mL,P = 0.648, respectively). No significant differences in complications, including deep vein thrombosis, pulmonary thromboembolism, and oozing, were noted between the two groups (all,P = 1.000). @*Conclusions@#The 3-h drain clamping method after primary TKA using posterior stabilized implant reduced the loss of postoperative drained blood. However, hidden blood loss was significantly higher in the 3-h drain clamping group; as a result, there were no differences in total blood loss and transfusion rate. The clamping method did not significantly alter the complication rate.

Layer-specific serotonergic induction of long-term depression in the prefrontal cortex of rats

Layer 2/3 pyramidal neurons (L2/3 PyNs) of the cortex extend their basal dendrites near the soma and as apical dendritic tufts in layer 1, which mainly receive feedforward and feedback inputs, respectively. It is suggested that neuromodulators such as serotonin and acetylcholine may regulate the information flow between brain structures depending on the brain state. However, little is known about the dendritic compartment-specific induction of synaptic transmission in single PyNs.Here, we studied layer-specific serotonergic and cholinergic induction of long-term synaptic plasticity in L2/3 PyNs of the agranular insular cortex, a lateral component of the orbitofrontal cortex. Using FM1-43 dye unloading, we verified that local electrical stimulation to layers 1 (L1) and 3 (L3) activated axon terminals mostly located in L1 and perisomatic area (L2/3). Independent and AMPA receptor-mediated excitatory postsynaptic potential was evoked by local electrical stimulation of either L1 or L3. Application of serotonin (5-HT, 10 μM) induced activity-dependent longterm depression (LTD) in L2/3 but not in L1 inputs. LTD induced by 5-HT was blocked by the 5-HT2 receptor antagonist ketanserin, an NMDA receptor antagonist and by intracellular Ca2+ chelation. The 5-HT2 receptor agonist α-me-5-HT mimicked the LTD induced by 5-HT. However, the application of carbachol induced muscarinic receptor-dependent LTD in both inputs. The differential layer-specific induction of LTD by neuromodulators might play an important role in information processing mechanism of the prefrontal cortex.

Open channel block of Kv1.4 potassium channels by aripiprazole

Aripiprazole is a quinolinone derivative approved as an atypical antipsychotic drug for the treatment of schizophrenia and bipolar disorder. It acts as with partial agonist activities at the dopamine D2 receptors. Although it is known to be relatively safe for patients with cardiac ailments, less is known about the effect of aripiprazole on voltage-gated ion channels such as transient A-type K+ channels, which are important for the repolarization of cardiac and neuronal action potentials. Here, we investigated the effects of aripiprazole on Kv1.4 currents expressed in HEK293 cells using a whole-cell patch-clamp technique. Aripiprazole blocked Kv1.4 channels in a concentration-dependent manner with an IC50 value of 4.4 μM and a Hill coefficient of 2.5. Aripiprazole also accelerated the activation (time-to-peak) and inactivation kinetics. Aripiprazole induced a voltage-dependent (δ = 0.17) inhibition, which was use-dependent with successive pulses on Kv1.4 currents without altering the time course of recovery from inactivation. Dehydroaripiprazole, an active metabolite of aripiprazole, inhibited Kv1.4 with an IC50 value of 6.3 μM (p < 0.05 compared with aripiprazole) with a Hill coefficient of 2.0. Furthermore, aripiprazole inhibited Kv4.3 currents to a similar extent in a concentration-dependent manner with an IC50 value of 4.9 μM and a Hill coefficient of 2.3. Thus, our results indicate that aripiprazole blocked Kv1.4 by preferentially binding to the open state of the channels.

How many emergency medicine residents reselect their specialty if they could?

Objective@#The 2019 Korean Emergency Medicine Residents Survey (KEMRS) is the first survey by the Korean Society of Emergency Medicine (KSEM) on the comprehensive satisfaction of their residents. Satisfaction is important not only for the personal well-being of the residents but also for patient safety. @*Methods@#A total of 622 emergency medicine residents were surveyed, using both a paper and email questionnaire from May to August of 2019. Factors related to satisfaction were analyzed. @*Results@#Of the responders, 66% said they would reapply for the emergency specialty and 51% said that they would reselect the same training hospital. The group of residents who said they would choose emergency medicine again felt that their expectations had been met and that they were comfortable with the choice of the specialty. They felt that the factors of satisfaction with their shift schedule and personal health played a more important role in their reselection of the training hospital than the workload. @*Conclusion@#The satisfaction levels of the Korean emergency residents were low. Thus, training hospitals should provide a reasonable working environment to increase their satisfaction. Also, it is important to create an environment where residents can feel rewarded and proud of the work they do.

Layer-specific serotonergic induction of long-term depression in the prefrontal cortex of rats

Layer 2/3 pyramidal neurons (L2/3 PyNs) of the cortex extend their basal dendrites near the soma and as apical dendritic tufts in layer 1, which mainly receive feedforward and feedback inputs, respectively. It is suggested that neuromodulators such as serotonin and acetylcholine may regulate the information flow between brain structures depending on the brain state. However, little is known about the dendritic compartment-specific induction of synaptic transmission in single PyNs.Here, we studied layer-specific serotonergic and cholinergic induction of long-term synaptic plasticity in L2/3 PyNs of the agranular insular cortex, a lateral component of the orbitofrontal cortex. Using FM1-43 dye unloading, we verified that local electrical stimulation to layers 1 (L1) and 3 (L3) activated axon terminals mostly located in L1 and perisomatic area (L2/3). Independent and AMPA receptor-mediated excitatory postsynaptic potential was evoked by local electrical stimulation of either L1 or L3. Application of serotonin (5-HT, 10 μM) induced activity-dependent longterm depression (LTD) in L2/3 but not in L1 inputs. LTD induced by 5-HT was blocked by the 5-HT2 receptor antagonist ketanserin, an NMDA receptor antagonist and by intracellular Ca2+ chelation. The 5-HT2 receptor agonist α-me-5-HT mimicked the LTD induced by 5-HT. However, the application of carbachol induced muscarinic receptor-dependent LTD in both inputs. The differential layer-specific induction of LTD by neuromodulators might play an important role in information processing mechanism of the prefrontal cortex.

Open channel block of Kv1.4 potassium channels by aripiprazole

Aripiprazole is a quinolinone derivative approved as an atypical antipsychotic drug for the treatment of schizophrenia and bipolar disorder. It acts as with partial agonist activities at the dopamine D2 receptors. Although it is known to be relatively safe for patients with cardiac ailments, less is known about the effect of aripiprazole on voltage-gated ion channels such as transient A-type K+ channels, which are important for the repolarization of cardiac and neuronal action potentials. Here, we investigated the effects of aripiprazole on Kv1.4 currents expressed in HEK293 cells using a whole-cell patch-clamp technique. Aripiprazole blocked Kv1.4 channels in a concentration-dependent manner with an IC50 value of 4.4 μM and a Hill coefficient of 2.5. Aripiprazole also accelerated the activation (time-to-peak) and inactivation kinetics. Aripiprazole induced a voltage-dependent (δ = 0.17) inhibition, which was use-dependent with successive pulses on Kv1.4 currents without altering the time course of recovery from inactivation. Dehydroaripiprazole, an active metabolite of aripiprazole, inhibited Kv1.4 with an IC50 value of 6.3 μM (p < 0.05 compared with aripiprazole) with a Hill coefficient of 2.0. Furthermore, aripiprazole inhibited Kv4.3 currents to a similar extent in a concentration-dependent manner with an IC50 value of 4.9 μM and a Hill coefficient of 2.3. Thus, our results indicate that aripiprazole blocked Kv1.4 by preferentially binding to the open state of the channels.

How many emergency medicine residents reselect their specialty if they could?

Objective@#The 2019 Korean Emergency Medicine Residents Survey (KEMRS) is the first survey by the Korean Society of Emergency Medicine (KSEM) on the comprehensive satisfaction of their residents. Satisfaction is important not only for the personal well-being of the residents but also for patient safety. @*Methods@#A total of 622 emergency medicine residents were surveyed, using both a paper and email questionnaire from May to August of 2019. Factors related to satisfaction were analyzed. @*Results@#Of the responders, 66% said they would reapply for the emergency specialty and 51% said that they would reselect the same training hospital. The group of residents who said they would choose emergency medicine again felt that their expectations had been met and that they were comfortable with the choice of the specialty. They felt that the factors of satisfaction with their shift schedule and personal health played a more important role in their reselection of the training hospital than the workload. @*Conclusion@#The satisfaction levels of the Korean emergency residents were low. Thus, training hospitals should provide a reasonable working environment to increase their satisfaction. Also, it is important to create an environment where residents can feel rewarded and proud of the work they do.

24-Hour shifts and frequent night shifts of Korean emergency medicine residents

OBJECTIVE@#The newly implemented Training Rule Standard limits the amount of resident working hours to serve the interests of the patients and residents alike. On the other hand, the law does not sufficiently protect emergency medicine residents from a long shift length and frequent night shift. Excessive shift work can cause physical and neuropsychological problems for residents. Therefore, this study examined the 24-hour shifts and night shifts status of emergency medicine residents at the training hospitals.@*METHODS@#The 30 training hospitals were divided into three groups according to the number of residents (≤4, 5-8, and ≥ 9) and the associations between each group and the 24-hour shifts, night shifts, number of working days, working hours, and annual patients per resident were checked. The associations between the resident grades and 24-hour shifts, night shifts, number of working days and working hours were also examined.@*RESULTS@#Hospital groups with fewer residents had the highest number of patients per resident with the highest number of 24-hour shifts and the highest number of night shifts. The first year residents had the highest number of 24-hour shifts, the highest number of night shifts, and the highest number of working hours.@*CONCLUSION@#More 24-hour shifts and more night shifts occur at hospitals that lack work force. Therefore, there is a need for new standards for limiting the working hours and frequency of night shifts in emergency rooms, and there is a need for discussions on reinforcing the work force.

Layer-specific cholinergic modulation of synaptic transmission in layer 2/3 pyramidal neurons of rat visual cortex

It is known that top-down associative inputs terminate on distal apical dendrites in layer 1 while bottom-up sensory inputs terminate on perisomatic dendrites of layer 2/3 pyramidal neurons (L2/3 PyNs) in primary sensory cortex. Since studies on synaptic transmission in layer 1 are sparse, we investigated the basic properties and cholinergic modulation of synaptic transmission in layer 1 and compared them to those in perisomatic dendrites of L2/3 PyNs of rat primary visual cortex. Using extracellular stimulations of layer 1 and layer 4, we evoked excitatory postsynaptic current/potential in synapses in distal apical dendrites (L1-EPSC/L1-EPSP) and those in perisomatic dendrites (L4-EPSC/L4-EPSP), respectively. Kinetics of L1-EPSC was slower than that of L4-EPSC. L1-EPSC showed presynaptic depression while L4-EPSC was facilitating. In contrast, inhibitory postsynaptic currents showed similar paired-pulse ratio between layer 1 and layer 4 stimulations with depression only at 100 Hz. Cholinergic stimulation induced presynaptic depression by activating muscarinic receptors in excitatory and inhibitory synapses to similar extents in both inputs. However, nicotinic stimulation enhanced excitatory synaptic transmission by ~20% in L4-EPSC. Rectification index of AMPA receptors and AMPA/NMDA ratio were similar between synapses in distal apical and perisomatic dendrites. These results provide basic properties and cholinergic modulation of synaptic transmission between distal apical and perisomatic dendrites in L2/3 PyNs of the visual cortex, which might be important for controlling information processing balance depending on attentional state.

A Case of Indeterminate Dendritic Cell Tumor: A Rare Neoplasm with Langerhans Cell Lineage

No abstract available.

Probability of Early Retirement Among Emergency Physicians / 예방의학회지

OBJECTIVES: Early retirement occurs when one's job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction. METHODS: A secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram. RESULTS: Of the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors. CONCLUSIONS: To promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

A Case of Primary Cutaneous Aggressive Epidermotropic CD8+ Cytotoxic T-Cell Lymphoma

No abstract available.

The Impact of Skin Problems on the Quality of Life in Patients Treated with Anticancer Agents: A Cross-Sectional Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Patients treated with anticancer agents often experience a variety of treatment-related skin problems, which can impair their quality of life. MATERIALS AND METHODS: In this cross-sectional study, Dermatology Life Quality Index (DLQI) and clinical information were evaluated in patients under active anticancer treatment using a questionnaire survey and their medical records review. RESULTS: Of 375 evaluated subjects with anticancer therapy, 136 (36.27%) and 114 (30.40%) were treated for breast cancer and colorectal cancer, respectively. We found that women, breast cancer, targeted agent use, and longer duration of anticancer therapy were associated with higher dermatology-specific quality of life distraction. In addition, itching, dry skin, easy bruising, pigmentation, papulopustules on face, periungual inflammation, nail changes, and palmoplantar lesions were associated with significantly higher DLQI scores. Periungual inflammation and palmoplantar lesions scored the highest DLQI. CONCLUSION: We believe our findings can be helpful to clinicians in counseling and managing the patients undergoing anticancer therapy.

Paraneoplastic Generalized Granuloma Annulare in a Patient with Hepatocellular Carcinoma

No abstract available.

Evaluation of Nonclinical Activities of Emergency Medicine Specialist Using Relative Value Unit: Pilot Study

PURPOSE: Emergency medicine (EM) specialists in training hospitals perform not only clinical practice, but also nonclinical activities, such as education, administration, and research. The types and amounts of nonclinical activities are increasing, but the activities have not been evaluated. This study applied the concept of the relative value unit (RVU) and conducted a pilot study to calculate the total nonclinical activities of EM specialists in training hospitals. METHODS: The one year nonclinical activities of the eight EM specialists working in training hospitals were analyzed retrospectively. The nonclinical activities were divided into three areas: education, administration, and research. The types of activities, and effort and time spent were collected and the RVU was calculated. RESULTS: The time spent on the education and administrative tasks ranged from 92 to 1,094 hours (average 348.8 hours) and 19 to 1,018 hours (average 207.8 hours), respectively. The average annual workload for education was 324.9 RVUs. The average annual administrative workload was 115.6 RUVs. The average time spent in education and administration was 556.6 hours and clinical practice was 1,904.8 hours. CONCLUSION: Nonclinical activities are essential for the operation of EM departments. If the necessary manpower for the EM is to be calculated, it will be important to calculate the workforce of the specialists, including the nonclinical workload.

Epstein-Barr Virus-Associated Vesiculopapular Eruption on the Face of a Patient with Natural Killer T Cell Lymphoma

Unlike typical hydroa vacciniforme (HV), Epstein-Barr virus (EBV)-associated HV-like eruption is more variable in its clinical manifestations. In some patients, progression to lymphoma or leukemia has been reported, which are characterized by the T-cell immunophenotype. Here, we report the first Korean case of EBV-associated vesiculopapular eruption on the face of a patient with natural killer (NK)/T cell lymphoma. A 32-year-old Korean man presented with a late adolescent-onset recurrent necrotic papulovesicles on his face. The patient was previously diagnosed with EBV-associated NK/T cell lymphoma of the oral cavity and also had childhood-onset hypersensitivity to mosquito bites. Biopsy of his facial skin showed EBV-associated vesiculopapular eruptions, though ultraviolet provocation did not reproduce the skin lesions. EBV viral load in his peripheral blood was detected but low. The patient was treated with systemic chemotherapy. The lymphoma went into remission, but the facial EBV-associated vesiculopapular eruption had a relapsing and remitting course.

A Case of Sebaceoma on the Right Earlobe / 대한피부과학회지

Sebaceoma, also known as sebaceous epithelioma, is a rare, benign, adnexal tumor with sebaceous differentiation. It usually appears as a yellowish papule, nodule, or plaque on the scalp and face, on which there are abundant sebaceous glands. Histologically, it is a well-circumscribed lesion composed of undifferentiated basaloid cells and mature sebaceous cells in relatively preserved lobulated architectures. A 31-year-old woman presented with a 1.3-cm ×1.1-cm nodule on the right earlobe. Mohs micrographic surgery was performed to completely remove it. Histopathological examination revealed that mature sebaceous cells with scalloped nuclei and focal cystic change were present in the lobule.