Development of a Modified Korean East Asian Student Stress Inventory by Comparing Stress Levels in Medical Students with Those in Non-Medical Students / 가정의학회지

BACKGROUND: Medical students are usually under more stress than that experienced by non-medical students. Stress testing tools for Korean medical students have not been sufficiently studied. Thus, we adapted and modified the East Asian Student Stress Inventory (EASSI), a stress testing tool for Korean students studying abroad, and verified its usefulness as a stress test in Korean university students. We also compared and analyzed stress levels between medical and non-medical students. METHODS: A questionnaire survey was conducted on medical and non-medical students of a national university, and the responses of 224 students were analyzed for this study. Factor analysis and reliability testing were performed based on data collected for 25 adapted EASSI questions and those on the Korean version of the Global Assessment of Recent Stress Scale (GARSS). A correlation analysis was performed between the 13 modified EASSI questions and the GARSS, and validity of the modified EASSI was verified by directly comparing stress levels between the two student groups. RESULTS: The 13 questions adapted for the EASSI were called the modified EASSI and classified into four factors through a factor analysis and reliability testing. The Pearson's correlation analysis revealed a significant correlation between the modified EASSI and the Korean version of the GARSS, suggesting a complementary strategy of using both tests. CONCLUSION: The validity and reliability of the EASSI were verified. The modified Korean EASSI could be a useful stress test for Korean medical students. Our results show that medical students were under more stress than that of non-medical students. Thus, these results could be helpful for managing stress in medical students.

Analysis of the Effect of Renal Replacement Therapy: In the Prolonged Extracorporeal Membrane Oxygenation Patients

BACKGROUND: This paper aimed to verify the effects of renal replacement therapy on changing the levels of serum creatinine for different veno-arterial and veno-venous configurations in prolonged extracorporeal membrane oxygenation (ECMO) patients. METHODS: The subjects were chosen 71 patients who had undergone more than 1,440 minutes (24 hours) of the therapy from among 117 patients who had undergone ECMO insertion between January 2008 and December 2012. The patients were separated into the veno-arterial configuration group I (51 patients) and the veno-venous configuration group II (20 patients). The difference in the level of serum creatinine (DeltaCr) between before or just after ECMO insertion (CrI) and the level when the pump time was between 2,880 and 4,320 minutes (CrF) was checked (DeltaCr=CrF-CrI), and the average DeltaCr for each group was compared using a Student t-test at the confidence interval (CI) of 95%. RESULTS: The change in the level of serum creatinine was an increase of 0.341 mg/dL (sigma=0.9202) for group I and a decrease of 0.120 mg/dL (sigma=1.5292) for group II. The change was significantly high for group I (p=0.011, CI=95%). Meanwhile, within group I, when renal replacement therapy was not done, there was a significant increase in the level of serum creatinine (p=0.009, CI=95%). CONCLUSION: For ECMO insertion patients whose pump time was more than 1,440 minutes, there was a significant change in the level of serum creatinine when renal replacement therapy was not done, for the veno-arterial configuration of group I.

A Treatment Case of Delayed Aortic Injury: The Patient with Posterior Rib Fracture

A 66-year-old male patient arrived at the emergency room with a crush injury to his chest. Multiple rib fractures, hemothorax on both sides, left scapular fracture, liver laceration, and retroperitoneal hematoma were found upon the radiologic examination. After closed thoracostomy, the patient had been initially admitted to the intensive care unit, but he was transferred to the general ward on the next day. On the 4th post-trauma day, the patient complained of severe pain and there was bloody drainage through the chest tube. This case is an exploration with the consideration of the possibility of major bleeding and the subsequent repair of the descending thoracic aorta. This case is regarded as a case in which the aorta wall was damaged as the sharp margin of the fractured ribs caused continuous irritation.

A Treatment Case of Endoscopic Removal of Left Ventricular Thrombus, During Coronary Artery Bypass Graft

Left ventricular thrombus is a common complication related to acute myocardial infarction. Removing this with an incision of the free wall of the left ventricle may cause fatal cardiac dysfunction or arrhythmias. Furthermore, performing incision and suture on the fragile myocardium of an acute myocardial infarction patient may cause serious bleeding complications. If there is a patient with left ventricular thrombus who needs thoracotomy for another reason, the case is attempted with the thought that if effective intraventricular visualization and manipulation can be done, fatalities caused by incision and suture may be reduced. For patients undergoing cardiopulmonary bypass, if intracardiac manipulation is required, an endoscope can be used, and given the potential complications after the incision and suturing of the infarcted tissue, the benefits are deemed sufficient.