Functional improvement after inpatient rehabilitation in community hospitals following acute hospital care

INTRODUCTION@#There are limited studies exploring functional improvement in relation to characteristics of patients who, following acute hospital care, receive inpatient rehabilitation in community hospitals. We evaluated the association of acute hospital admission-related factors with functional improvement on community hospital discharge.@*METHODS@#We conducted a retrospective cohort study among patients who were transferred to community hospitals within 14-day post-discharge from acute hospital between 2016 and 2018. Modified Barthel Index (MBI) on a 100-point ordinal scale was used to assess functional status on admission to and discharge from the community hospital. We categorised MBI into 6 bands: 0-24, 25-49, 50-74, 75-90, 91-99 and 100. Multivariable logistic regression models were constructed to determine factors associated with categorical improvement in functional status, defined as an increase in at least one MBI band between admission and discharge.@*RESULTS@#A total of 5,641 patients (median age 77 years, interquartile range 69-84; 44.2% men) were included for analysis. After adjusting for potential confounders, factors associated with functional improvement were younger age, a higher MBI on admission, and musculoskeletal diagnosis for the acute hospital admission episode. In contrast, a history of dementia or stroke; lower estimated glomerular filtration rate; abnormal serum albumin or anaemia measured during the acute hospital episode; and diagnoses of stroke, cardiac disease, malignancy, falls or pneumonia; and other chronic respiratory diseases were associated with lower odds of functional improvement.@*CONCLUSION@#Clinicians may want to take into account the presence of these high-risk factors in their patients when planning rehabilitation programmes, in order to maximise the likelihood of functional improvement.

O prognóstico da doença arterial coronariana em um Hospital Público no Brasil: Achado do estudo ERICO / The prognosis of coronary artery disease in a brazilian community hospital: Findings from the ERICO study

Resumo Fundamento O prognóstico de longo prazo pós síndrome coronária aguda (SCA) no cuidado secundário não é bem conhecido. A gravidade da doença arterial coronariana (DAC) como preditor de mortalidade no longo prazo foi avaliada em um hospital público no Brasil. Objetivo O objetivo deste estudo foi comparar o prognóstico de curto e longo prazo após um evento de SCA, de acordo com a gravidade da doença obstrutiva, em pacientes atendidos em um hospital público secundário para um coorte prospectivo sobre DAC no Brasil (o Estudo de Registro de Insuficiência Coronariana, estudo ERICO) Métodos Foram realizadas análises de sobrevida por curvas de Kaplan-Meier e modelo de risco proporcional de Cox [razão de risco (RR) com o respectivo intervalo de confiança (IC) de 95% para avaliar mortalidade cumulativa global, por DCV e DAC, de acordo com a obstrução arterial coronária: sem obstrução (grupo de referência), doença de um vaso, doença de dois vasos, doença de múltiplos vasos] entre 800 adultos do estudo ERICO durante 4 anos de monitoramento. As RR são apresentadas como dados brutos e posteriormente padronizadas quanto a possíveis fatores de confusão, no período de 180 dias até 4 anos de monitoramento após a SCA. O p-valor <0.05 foi considerado estatisticamente significativo. Resultados Taxas de sobrevida mais baixas foram detectadas entre indivíduos com a doença de múltiplos vasos (global, DCV e DAC, p de teste de Log-rank <0,0001). Depois da padronização multivariada, a doença de múltiplos vasos [RR; 2,33 (IC 95%; 1,10-4,95)] e doença de um vaso obstruído [RR; 2,44 (IC 95%; 1,11-5,34)] tiveram o risco mais alto de mortalidade global comparadas aos índices dos sujeitos sem obstrução no monitoramento de 4 anos. Conclusões Não só os pacientes com doença de múltiplos vasos como também os com doença de um vaso tiveram alto risco de mortalidade no longo prazo pós-SCA. Esses achados destacam a importância de se ter uma abordagem melhor no tratamento e no controle de fatores de risco cardiovascular, mesmo em indivíduos com risco aparentemente baixo, atendidos em cuidado secundário.

Abstract Background Long-term prognosis post-acute coronary syndrome (ACS) in secondary care is not well-known. The severity of coronary artery disease (CAD) as a predictor of long-term mortality was evaluated in a community hospital in Brazil. Objective We aimed to compare short and long-term prognosis after an ACS event according to severity of obstructive disease in patients attended in a secondary community hospital from prospective CAD cohort in Brazil (the Strategy of Registry of Acute Coronary Syndrome, ERICO study). Methods Survival analyses were performed by Kaplan-Meier curves and Cox proportional hazard models (hazard ratios (HR) with respective 95% confidence interval (CI) to evaluate cumulative all-cause, CVD and CAD mortality according the coronary artery obstruction: no-obstruction (reference group), 1-vessel-disease, 2-vessel-disease, multivessel-disease) among 800 adults from an ERICO study during a 4-year-follow-up. HR are presented as crude and further adjusted for potential confounders from 180 days to 4-year follow-up after ACS. A p-value <0.05 was considered statistically significant. Results Poorer survival rates were detected among individuals with multivessel-disease (all-cause, CVD and CAD, p-log rank< 0.0001). After multivariate adjustments, multivessel-disease -(HR; 2.33 (CI 95%; 1.10-4.95)) and 1-vessel-disease obstructed (HR; 2.44 (CI 95%; 1.11-5.34)) had the highest risk for all-cause mortality compared to those with no obstruction at 4-year follow-up. Conclusions Not only multivessel-disease, but also 1-vessel-disease patients showed a high long-term mortality risk post-ACS. These findings highlight the importance of having a better approach in the treatment and control of cardiovascular risk even in apparently low-risk individuals attended to in secondary care.

What patients consider to be a good doctor, and what doctors consider to be a good patient / Cómo definen los pacientes a un buen médico, y cómo definen los médicos a un buen paciente

ABSTRACT Background: From a patient's point of view, an 'ideal' doctor could be defined as one having personal qualities for interpersonal relationships, technical skills and good intentions. However, doctors' opinions about what it means to be a 'good' patient have not been systematically investigated. Aim: To explore how patients define the characteristics of a 'good' and a 'bad' doctor, and how doctors define a 'good' and a 'bad' patient. Material and Methods: We surveyed a cohort of 107 consecutive patients attending a community teaching hospital in February 2019, who were asked to define the desirable characteristics of a good/bad doctor. Additionally, a cohort of 115 physicians working at the same hospital was asked to define the desirable characteristics of a good/bad patient. Responses were subjected to content analysis. Simultaneously, an algorithm in Python was used to automatically categorize responses throughout text-mining. Results: The predominant patients' perspective alluded to desirable personal qualities more importantly than proficiency in knowledge and technical skills. Doctors would be satisfied if patients manifested positive personality characteristics, were prone to avoid decisional and personal conflicts, had a high adherence to treatment, and trusted the doctor. The text-mining algorithm was accurate to classify individuals' opinions. Conclusions: Ideally, fusing the skills of the scientist to the reflective capabilities of the medical humanist will fulfill the archetype of what patients consider to be a 'good' doctor. Doctors' preferences reveal a "paternalistic" style, and his/her opinions should be managed carefully to avoid stigmatizing certain patients' behaviors.

Antecedentes: Desde la perspectiva del paciente, un médico "ideal" podría definirse como aquel que tiene cualidades para las relaciones interpersonales, habilidades técnicas y buenas intenciones. Sin embargo, las opiniones de los médicos sobre lo que significa ser un "buen" paciente no se han investigado sistemáticamente. Objetivo: Explorar cómo los pacientes definen las características de un "buen" y "mal" médico, y cómo los médicos definen un "buen" y "mal" paciente. Material y Métodos: Encuestamos a una cohorte de 107 pacientes consecutivos que asistieron a un hospital comunitario en febrero de 2019, a quienes se les pidió que definieran las características deseables de un médico bueno/malo. Además, se pidió a una cohorte de 115 médicos que trabajaban en el mismo hospital que definieran las características deseables de un paciente bueno/malo. Las respuestas se sometieron a un análisis de contenido. Simultáneamente, se utilizó un algoritmo en Python para clasificar automáticamente las respuestas mediante minería de texto. Resultados: Los pacientes aludieron que las cualidades personales del médico eran más importantes que la competencia en conocimiento y las habilidades técnicas. Los médicos estarían satisfechos si los pacientes mostraran características positivas de personalidad, fueran propensos a evitar conflictos, tuvieran una alta adherencia al tratamiento y confiaran en el médico. El algoritmo de minería de texto clasificó las opiniones de los encuestados en forma precisa. Conclusiones: Idealmente, fusionar las habilidades del científico con las capacidades reflexivas del médico humanista cumplirá con el arquetipo de lo que los pacientes consideran un "buen" médico. Las preferencias de los médicos revelan un estilo "paternalista", y sus opiniones deben manejarse con cuidado para evitar estigmatizar los comportamientos de ciertos pacientes.

Cirugía robótica colorectal, en un hospital de comunidad cerrada: experiencia inicial leído en sesión SACP, 11 de octubre de 2019 / Colorectal robotic surgery in a closed community hospital: initial experience read in SACP session, october 11, 2019

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.

Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.

Review of Physician Referrals to Orthopedic Spine versus Neurosurgery

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.

Experiences of Blood Bank Performance in Brian Allgood Army Community Hospital / 대한수혈학회지

Brian Allgood Army Community Hospital (BAACH) is one of the US military General Hospitals in Korea that have blood services. The author of this paper is a civilian employee who has been working in the blood bank for 37 years. Through this experience, a difference between BAACH and the Korean Medical Center has been observed. First, BAACH performs a blood culture for the sterility test upon the receipt of platelets from the Korean Red Cross, and measures the pH at the end of allowable storage. Second, some military facilities use the Frozen Blood Program as the storage/thawing system of Deglycerolized Red Blood Cells (DRBC) and the use of DRBC. Third, most military facilities have a continuous training education program for those working in the blood bank provided by the Armed Service Blood Program.

Mixed Neuroendocrine-non-neuroendocrine Neoplasm of the Stomach that is Distributed in Depth on the Same Tumor: Inconsistent with the Definition of Mixed Adenoneuroendocrine Carcinoma in the 2010 World Health Organization Classification of Tumors of the Digestive System / 대한소화기학회지

A mixed adenoneuroendocrine carcinoma (MANEC) of the stomach is a rare disease entity that was first defined by the World Health Organization (WHO) classification (2010) for tumors of the digestive system. According to the WHO classification (2010), MANEC is referred to as a tumor with both neuroendocrine and non-neuroendocrine neoplasms; each component of the tumor should be at least 30%. On the other hand, this cut-off value lacks clinical evidence and does not explain the characteristics and heterogeneity of this tumor. A 66-year-old male diagnosed with early gastric cancer (EGC) at a community hospital was referred to the Kosin University Gospel Hospital for further evaluation of gastric cancer. Esophagogastroduodenoscopy and EUS performed at the Kosin University Gospel Hospital revealed a sub-mucosal tumor-like component. In addition, a re-biopsy revealed a neuroendorine tumor at different depths of the same tumor. The final pathologic-diagnosis through surgery revealed a mixed neuroendocrine-non-neuroendocrine neoplasm, which is inconsistent with the definition of MANEC. Clinicians should consider EUS when a tumor has atypical endoscopic findings, even if EGC has already been diagnosed.

Health care perspectives on community care

The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.

Seasonal and Temperature-Associated Increase in Community-Onset Acinetobacter baumannii Complex Colonization or Infection

Identifying the trends in community-onset Acinetobacter baumannii complex isolation and diversity according to temperature could help provide insight into the behavior of the A. baumannii complex. We performed a retrospective analysis of A. baumannii complex (Acinetobacter baumannii, Acinetobacter nosocomialis, Acinetobacter pittii, and Acinetobacter calcoaceticus) isolates obtained from patients at a Korean community hospital from 2006 to 2015 with reference to seasonal temperatures. The incidence rates were compared between warm (June–September) and cold (November–March) months, defined as an average mean temperature ≥20℃ and ≤5℃, respectively. Incidence rate was calculated as the number of cases per month, converted to cases/10⁵ admissions for healthcare-acquired isolates and cases/10³ outpatients for community-onset isolates. Approximately 3,500 A. baumannii complex cases were identified, and 26.2% of them were community-onset cases. The median (interquartile range) number of community-onset A. baumannii complex cases was significantly higher (P=0.0002) in warm months at 13.8 (9.5–17.6) than in cold months at 10.1 (6.3–13.2). There was a strong correlation between community-onset A. baumannii complex cases and temperature (Pearson's r=0.6805, P=0.0149). Thus, we identified a seasonality pattern for community-onset A. baumannii complex colonization or infection, but not for healthcare-acquired cases.

Herpes zoster en adultos mayores en un hospital privado de la ciudad de Buenos Aires, junio 2013 - mayo 2014 / Herpes zoster in elderly adults in a community hospital in Buenos Aires. June 2013-May 2014

El herpes zoster (HZ) se produce por reactivación del virus varicela zoster. Sus principales factores de riesgo son edad avanzada y presencia de comorbilidades (diabetes, inmunodepresión). Existen escasos datos de HZ en Sudamérica, y especialmente en adultos mayores. Analizamos retrospectivamente las características epidemiológicas y clínicas de 340 pacientes mayores de 60 años atendidos por HZ, entre junio 2013 y mayo 2014. La edad promedio de consulta fue de 74 años (60-100), localización torácica 210 (62%); el 75% (255) de las consultas iniciales se realizaron en guardias. El 68%, 143, presentaron dolor y vesículas, y 4% (14) solo dolor al inicio; el dolor persistió luego de finalizar el episodio en el 41% (139) de los pacientes. El diagnóstico se realizó entre 1 y 3 días de iniciado el cuadro en el 53% (180). El promedio de consultas por episodio fue de 3.6 (1-24). Tratamiento antiviral se indicó en 91% (309) de los pacientes [en 49% (167) fue inadecuado en tiempo o dosis], y tratamiento para el dolor en el 66% (224) de los casos: drogas más usadas (solas o en combinación) AINES (43%, 146), pregabalina (30%, 102), opiáceos (24%, 82), y corticoides (12%, 41). Solo el 9% (31) presentó comorbilidades y el 27% (126) dolor post episodio (duración promedio: 138.7 días). El diagnóstico fue tardío, dificultando el uso correcto de antivirales. El dolor post episodio fue más frecuente que en la literatura consultada; sin embargo, son pocos los datos en este grupo etario.

Herpes zoster (HZ) is caused by reactivation of the varicella zoster virus. Its main risk factor is increasing age and comorbidities. There are limited data on the characteristics of HZ in South America, especially in the elderly. We analyzed epidemiological and clinical characteristics of 340 patients over 60 years assisted for HZ, between June 2013 and May 2014. The average age was 74 years (60-100), 62% (210) had thoracic location; 75% (255) of the initial consultations were held in guards; 68% (143) had pain and vesicles, and 4% (14) only pain at baseline. Pain persisted after finishing the episode in 41% (139). The diagnosis was made between 1 and 3 days from the beginning of the episode in 53% (180 patients). Average number of visits per episode was 3.6 (1-24). Antiviral treatment was supplied to 91% (309); however it was inadequate in dose or time in 49.1% (167 cases). Pain treatment was indicated in 66% (224). Most frequently used drugs (alone or in combination) were non-steroidal painkillers (43%, 146), pregabalin (30%, 102), opiates (24%, 82), and steroids (12%, 41); 9% (31) presented comorbidities; 27% (126) experienced pain after the ending of the episode, with an average duration of 138.7 days. In general, diagnosis was done late, making it difficult to use antivirals correctly. The presence of pain was more frequent than reported in other publications, however there are few data in this age group.

Static model simulation for routine mumps vaccination in Japan: with a result of mumps-related complications in a Japanese community hospital

PURPOSE: Mumps vaccine has not been included in the routine national immunization program in Japan, leading to low vaccine coverage rates and periodic epidemics approximately every 5 years. Our hospital (a secondary community hospital in Japan) experienced an increased number of mumps-related complications with a nationwide epidemic in 2016. Using previously reported data and mumps-related cases in our hospital, we estimated the cost-effectiveness of routine mumps vaccination in Japan with a static model using current epidemiologic data. MATERIALS AND METHODS: With a decision tree flowchart of mumps infection and adverse events, we estimated the burden of mumps-related complications in our hospital for 5 years, and calculated the current annual national burden. Finally, we compared the current burden and assumptive burden of the stable state after routine vaccination in Japan using a static model. RESULTS: The cost-benefit ratios with sensitivity analysis were 3.69 (1.08-9.52) and 6.84 (1.51-23.73) in independent inoculation and simultaneous inoculation, respectively, from a social perspective in addition to an annual gain of 9,487 (3,227-14,659) quality adjusted life years. CONCLUSION: We contributed additional evidence in terms of cost-effectiveness that routine mumps vaccination should be introduced in Japan with simultaneous inoculation.

Parenting Experience of Mother of Teenage Girls with Conduct Disorder: A Parse's Method Study / 정신간호학회지

PURPOSE: The aim of this study was to identify the parenting experience of mothers who have teenage girls with conduct disorders and to identify the meaning and structure of their experiences. METHODS: This study was a qualitative research based on Parse's research method. Participants were 9 mothers who had a daughter diagnosed with conduct disorder at a community hospital in the central region of South Korea. RESULTS: The core concept on the parenting experiences of mothers of teenage girls with conduct disorder were survival against a violent environment, a sense of guilt related to the conduct disorder, confusion and frustration concerning mother's role, and hope for the future. The experiences of these mothers can be defined as the process of human becoming with powering and transforming while connecting-separating and enabling-limiting with valuing. CONCLUSION: This research is expected to contribute to understanding of mothers' suffering and struggling and be useful in developing nursing care for clients with conduct disorder and their mothers.

A translação do conhecimento no âmbito da cooperação internacional: a experiência da Fiocruz em incorporação de tecnologias em saúde no Haiti / The translation of knowledge in the ambit of international cooperation: the experience of Fiocruz in introducing health technologies to Haiti

Para examinar o debate sobre cooperação internacional Sul-Sul, realizou-se uma análise do curso de Gestão dos Recursos Físicos e Tecnológicos em Saúde no Haiti, parceria Fiocruz e ministérios da Saúde do Brasil e do Haiti, que teve como finalidade construir viabilidade para o funcionamento das unidades construídas pelo Brasil, contribuindo para a sustentabilidade do projeto de cooperação tripartite. O formato adotado pelo curso, de formulação de projetos de intervenção para superar problemas reais identificados pelos alunos, possibilitou a construção de oito pré-projetos de intervenção, voltados para superação de problemas de gestão nos hospitais comunitários de referência construídos pelo Brasil no Haiti.

To investigate the debate about South-South cooperation, we conducted an analysis of a course on the Management of Physical and Technological Resources in Health given in Haiti as part of a partnership between Fiocruz and the Brazilian and Haitian ministries of health with the aim of enabling the functioning of the units built by Brazil, contributing to the sustainability of the tripartite cooperation project. The course format – designing interventions to overcome real problems identified by the students – resulted in the development of eight intervention pre-projects geared towards overcoming management problems at the reference community hospitals built by Brazil in Haiti.

Difference in the epidemiologic and clinical characteristics by age groups of the children who visited a hand center emergency department with a hand injury requiring surgery

PURPOSE: We aimed to describe the difference in the epidemiologic and clinical characteristics by age groups of the children with hand injuries requiring surgery who visited the emergency department (ED) of a community hospital that runs a hand center. METHODS: We reviewed 388 consecutive children with hand injuries requiring surgery, aged < 16 years, who visited the ED from January 2011 through September 2016. Information was obtained regarding age and gender of the children, seasonal and daily distribution of the visits, location, cause, site, and level of the injury, the diagnosis, and presence of serious injury. The children were classified into 3 age groups; toddlers (0 to 3 years), preschoolers (4 to 6 years), and schoolers (7 to 15 years). Severe injury was defined as amputation or crush injury. RESULTS: Mean age of the children was 7.4 ± 5.0 years and boys accounted for 65.7%. The most frequent visits occurred during the weekend (53.1%) and in spring (30.7%), and most children visited the ED with injuries that occurred at home and indoors (55.2% and 79.9%, respectively). The most common cause, site, and level of the injury were sharp object (34.8%), fingers other than the thumb and index finger (64.7%), and the distal phalanx (46.7%), respectively. In the toddler group, domestic, indoor, door-related, and distal phalanx injuries were more common than in the schooler group (P < 0.001). Physical contact or sharp object-related injuries increased with increasing age (P < 0.001). Severe injuries were more common among the toddlers than the schoolers (P < 0.001). CONCLUSION: In the toddler group, domestic, indoor, door-related, distal phalanx, and severe injuries were more common than in the schooler group. These characteristics by age groups would aid in preventing hand injury in children, especially toddlers.

Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth

PURPOSE: This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). METHODS: We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. RESULTS: From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. CONCLUSIONS: Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics / 가정의학회지

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics / 가정의학회지

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.

Epidemiologic characteristics of children who visited an emergency department: a single center study over three years

PURPOSE: Increasing visit of children to emergency departments (EDs) necessitates the effort to expand pediatric emergency medicine resources. We conducted this study to understand the epidemiologic characteristics of children who visited a community hospital ED. METHODS: The medical records of 32,031 children aged younger than 18 years were reviewed retrospectively from January 2013 to December 2015. We analyzed the age distribution, season, day, and time of visit, cause of visit, test performed, initial diagnosis, injury mechanisms, and disposition. RESULTS: Mean age of the children was 6.2±5.1 years and boys accounted for 59.1%. Children who had disease (65.5%) and aged 1 to 4 years (41.9%) accounted for the largest population. There was no difference of age distribution through seasons (P = 0.07). The proportions of children with disease and injury were the highest during winter (72.5%) and autumn (38.2%), respectively (P < 0.001). Children tended to visit the ED more frequently during non-business hours. In particular, children who aged 1 to 4 years, had disease or were slight ill visited the ED more frequently during this period (P < 0.001). Plain abdomen radiographs and urinalyses were performed to 29.8% and 16.1% of the children, respectively. Functional gastrointestinal disorder (20.3%) and laceration (30.1%) were the most common initial diagnoses among the children with disease and injury, respectively. The most common injury mechanism was struck injury (29.7%). After the treatment, 94.4% of the children were sent home from the ED. Of the remaining children, 5.5% were admitted, 0.1% were transferred to other hospitals, and 0.04% expired. CONCLUSION: Children who aged 1 to 4 years, had disease or were slight ill visited the ED more frequently during non-business hours than business hours. Pediatric emergency medicine resources should be expanded in consideration of this.