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1.
Article in Korean | WPRIM | ID: wpr-875096

ABSTRACT

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.

2.
Article | WPRIM | ID: wpr-834974

ABSTRACT

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.

3.
Article in English | WPRIM | ID: wpr-761804

ABSTRACT

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.


Subject(s)
Animals , Electronic Data Processing , Dendrites , Depression , Inhibitory Postsynaptic Potentials , Kinetics , Pyramidal Cells , Rats , Receptors, AMPA , Receptors, Muscarinic , Synapses , Synaptic Transmission , Visual Cortex
4.
Article in English | WPRIM | ID: wpr-714766

ABSTRACT

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.


Subject(s)
Compensation and Redress , Defamation , Emergencies , Emergency Medicine , Emergency Service, Hospital , Employment , Humans , Intention , Intrinsic Factor , Job Satisfaction , Logistic Models , Longevity , Nomograms , Professionalism , Retirement , Risk Factors , Surveys and Questionnaires
6.
Cancer Research and Treatment ; : 1186-1193, 2018.
Article in English | WPRIM | ID: wpr-717749

ABSTRACT

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.


Subject(s)
Antineoplastic Agents , Breast Neoplasms , Colorectal Neoplasms , Counseling , Cross-Sectional Studies , Dermatology , Drug-Related Side Effects and Adverse Reactions , Female , Humans , Inflammation , Medical Records , Pigmentation , Pruritus , Quality of Life , Skin
9.
Annals of Dermatology ; : 618-620, 2017.
Article in English | WPRIM | ID: wpr-226478

ABSTRACT

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.


Subject(s)
Adult , Biopsy , Culicidae , Drug Therapy , Herpesvirus 4, Human , Humans , Hydroa Vacciniforme , Hypersensitivity , Leukemia , Lymphoma , Mouth , Natural Killer T-Cells , Skin , T-Lymphocytes , Viral Load
10.
Article in Korean | WPRIM | ID: wpr-53391

ABSTRACT

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.


Subject(s)
Education , Emergencies , Emergency Medicine , Pilot Projects , Retrospective Studies , Specialization
11.
Article in Korean | WPRIM | ID: wpr-182983

ABSTRACT

BACKGROUND: Longitudinal melanonychia is characterized by pigmented bands on the nail plate. It is not unusual to encounter pediatric melanonychia patients in the dermatologic clinic. OBJECTIVE: To assess the clinical manifestations of melanonychia in childhood in Korea, we reviewed the pediatric patient registry of a tertiary referral hospital in Korea. METHODS: Patients under fifteen years of age with longitudinal melanonychia referred between January, 2001, and March, 2015, were enrolled in the study. All patients had clinical as well as photo records. Clinical characteristics including age, sex, location, disease duration, width and color of pigmentation, morphological change over time, underlying disease, and dermoscopic images or biopsy findings were evaluated where available. RESULTS: A total of 92 patients had 158 pigmented nails, with more than one melanonychia identified in 14 patients. The patient sample included 43 male and 49 female patients with an average age of 6.1 years at diagnosis. A follow-up examination was performed for 132 nails in 80 patients with a mean period of 27.8 months and morphological changes were identified in 61 nails. Changes included remission or aggravation of pigmentation. In 48% and 17% of patients, nail plate dystrophy and Hutchinson's sign were observed, respectively. Dermoscopic image analysis was available for 79 nails. A nail biopsy was performed for 8 nails and none showed evidence of malignant melanoma. CONCLUSION: Pediatric longitudinal melanonychia generally presents a benign nature despite overt morphological changes, diffuse pigmentation, or Hutchinson's sign. Characteristically, melanonychia in childhood is frequently accompanied by nail dystrophy. Based on clinical reference of our study, aggressive nail biopsy may not be routinely necessary in pediatric melanonychia.


Subject(s)
Biopsy , Diagnosis , Female , Follow-Up Studies , Humans , Korea , Male , Melanoma , Pigmentation , Tertiary Care Centers
12.
Article in Korean | WPRIM | ID: wpr-219292

ABSTRACT

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.


Subject(s)
Adult , Carcinoma , Female , Humans , Mohs Surgery , Pectinidae , Scalp , Sebaceous Glands
13.
Article in English | WPRIM | ID: wpr-728435

ABSTRACT

Recently, it was reported that the role of mitochondria-reactive oxygen species (ROS) generating pathway in cisplatin-induced apoptosis is remarkable. Since a variety of molecules are involved in the pathway, a comprehensive approach to delineate the biological interactions of the molecules is required. However, quantitative modeling of the mitochondria-ROS generating pathway based on experiment and systemic analysis using the model have not been attempted so far. Thus, we conducted experiments to measure the concentration changes of critical molecules associated with mitochondrial apoptosis in both human mesothelioma H2052 and their ρ0 cells lacking mitochondrial DNA (mtDNA). Based on the experiments, a novel mathematical model that can represent the essential dynamics of the mitochondrial apoptotic pathway induced by cisplatin was developed. The kinetic parameter values of the mathematical model were estimated from the experimental data. Then, we have investigated the dynamical properties of this model and predicted the apoptosis levels for various concentrations of cisplatin beyond the range of experiments. From parametric perturbation analysis, we further found that apoptosis will reach its saturation level beyond a certain critical cisplatin concentration.


Subject(s)
Apoptosis , Cisplatin , DNA, Mitochondrial , Humans , Mesothelioma , Models, Theoretical , Oxygen , Systems Analysis
15.
Article in Korean | WPRIM | ID: wpr-160736

ABSTRACT

PURPOSE: Emergency Medicine became a medical specialty in Korea more than 20 years ago. However, Emergency Medicine is struggling due to lack of enthusiasm from young physicians. Working conditions, personal well-being, and all around satisfaction were analyzed in a survey to determine the reality. METHODS: A survey was conducted in 2010. The survey consisted of personal interests, working conditions, and salaries of members of the Korean Society of Emergency Medicine (KSEM). Several factors were estimated to evaluate the satisfaction of emergency physicians (EP). RESULTS: A total of 394 survey results were collected from 635 currently working emergency physicians out of 841 registered EPs. In the survey 48.6% of EPs were considering retiring from current practice. The preferred retirement age was 55. The survey also showed that many EPs considered that night shift was possible up to age 50. According to the responses, 50.5% of EPs in their 30s, 53.4% of EPs in their 40s were considering retiring. Factors influencing their decision were burnout, night shift, age, health issues, rather than social isolation, litigation, and disappointment. However the disappointment was the only statistically significant factor influencing retirement. Using a ten point Likert scale, the score for satisfaction with residency training was 6.4; when asked if they would choose Emergency Medicine again, the score was 5.5; the score for satisfaction with the Korean Emergency Medical Service System was 3.9; the score for prospects of emergency medicine in 10 years was 5.8. CONCLUSION: Korean emergency physicians are under a lot of stress from the job and are unsatisfied. Many in their 30s and 40s are considering retiring from practice. Therefore, establishment of clear cut standards on working hours and environments is imperative to improve the satisfaction of working emergency physicians.


Subject(s)
Emergencies , Emergency Medical Services , Emergency Medicine , Humans , Internship and Residency , Job Satisfaction , Jurisprudence , Korea , Retirement , Salaries and Fringe Benefits , Social Isolation , Surveys and Questionnaires
16.
Annals of Dermatology ; : 641-642, 2016.
Article in English | WPRIM | ID: wpr-129778

ABSTRACT

No abstract available.

17.
Annals of Dermatology ; : 641-642, 2016.
Article in English | WPRIM | ID: wpr-129763

ABSTRACT

No abstract available.

18.
Article in English | WPRIM | ID: wpr-190706

ABSTRACT

Analysis of the T-cell receptor (TCR) repertoire of innate CD4+ T cells selected by major histocompatibility complex (MHC) class II-dependent thymocyte-thymocyte (T-T) interaction (T-T CD4+ T cells) is essential for predicting the characteristics of the antigens that bind to these T cells and for distinguishing T-T CD4+ T cells from other types of innate T cells. Using the TCRmini Tg mouse model, we show that the repertoire of TCRalpha chains in T-T CD4+ T cells was extremely diverse, in contrast to the repertoires previously described for other types of innate T cells. The TCRalpha chain sequences significantly overlapped between T-T CD4+ T cells and conventional CD4+ T cells in the thymus and spleen. However, the diversity of the TCRalpha repertoire of T-T CD4+ T cells seemed to be restricted compared with that of conventional CD4+ T cells. Interestingly, the frequency of the parental OT-II TCRalpha chains was significantly reduced in the process of T-T interaction. This diverse and shifted repertoire in T-T CD4+ T cells has biological relevance in terms of defense against diverse pathogens and a possible regulatory role during peripheral T-T interaction.


Subject(s)
Amino Acid Sequence , Animals , Antigens, Surface/metabolism , CD4-Positive T-Lymphocytes/cytology , Cell Communication , Cell Differentiation/genetics , Clonal Evolution , Histocompatibility Antigens Class II/immunology , Immunity, Innate , Immunophenotyping , Lymphocyte Count , Mice , Mice, Knockout , Mice, Transgenic , Peptide Fragments/chemistry , Phenotype , Receptors, Antigen, T-Cell/chemistry , Receptors, Antigen, T-Cell, alpha-beta/chemistry , Spleen/cytology , Thymocytes/cytology
20.
Article in Korean | WPRIM | ID: wpr-9529

ABSTRACT

Various treatment modalities are available for mycosis fungoides including topical steroids, topical chemotherapy, phototherapy, and spot radiation therapy. However, these modalities do not always result in optimal effects, with efficacy depending on lesion size, number, and location. Photodynamic therapy (PDT) is a recently introduced therapeutic modality that proved effective in patients with unilesional mycosis fungoides. A 58-year-old woman presented with a seven-year history of a pruritic erythematous scaly patch on her right thigh. Through skin biopsy, we verified the lesion as mycosis fungoides. The lesion did not respond well to a topical steroid. We opted for topical PDT with methyl-aminolevulinate (MAL). MAL cream was applied for 4 hours following irradiation with a red light. Four sessions were administered, separated by five weeks. The lesion clinically improved after treatment without severe side effects. PDT using MAL could be considered an effective and tolerable treatment for mycosis fungoides.


Subject(s)
Biopsy , Drug Therapy , Female , Humans , Middle Aged , Mycosis Fungoides , Photochemotherapy , Phototherapy , Skin , Steroids , Thigh
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