Association of Intern and Resident Burnout with Self-Reported Medical Errors / 가정의학회지

BACKGROUND: Burnout is a common problem for interns and residents. It may be related to medical error, but little is known about this relationship. The purpose of this study was to determine the association between burnout and perceived medical errors among interns and residents. METHODS: The study group consisted of interns and residents working in a university hospital in Busan. Data were provided by 86 (58.5%) of 147 interns and residents. They completed a questionnaire including self-assessment of medical errors, a linear analog self-assessment of overall quality of life (QOL), fatigue, the Epworth Sleepiness Scale (ESS) score, the Maslach Burnout Inventory, and a validated depression screening tool. RESULTS: According to univariate logistic regression analyses, there was an association between perceived medical errors and fatigue (odds ratio [OR], 1.37 per unit increase; 95% confidence interval [CI], 1.12 to 1.69; P < 0.003) and ESS scores (OR, 1.13 per unit increase; 95% CI, 1.03 to 1.23; P < 0.009). Perceived medical errors were also associated with burnout (ORs per 1-unit change; emotional exhaustion OR, 1.07; 95% CI, 1.02 to 1.13; P < 0.005; depersonalization OR, 1.11; 95% CI, 1.02 to 1.21; P < 0.013), a negative depression screen (OR, 0.29; 95% CI, 0.11 to 0.76; P < 0.013), and overall QOL (OR, 0.80; 95% CI, 0.70 to 0.98; P < 0.033). In multivariate logistic regression analyses, an association was identified between perceived medical errors and emotional exhaustion (OR, 1.06; 95% CI, 1.00 to 1.11; P < 0.046) when adjusted for ESS, and depersonalization (OR, 1.01; 95% CI, 1.01 to 1.19; P < 0.04) when adjusted for fatigue. CONCLUSION: Higher levels of burnout among interns and residents were associated with perceived medical errors.

Relationship between Occupational Stress and Gastric Disease in Male Workers / 가정의학회지

BACKGROUND: Physical and mental health of workers is threatened due to various events and chronic occupational stress. This study was conducted to investigate the relationship between occupational stress and gastric disease in male workers of the shipbuilding industry. METHODS: Occupational stress measured among a total of 498 workers of a shipbuilding firm who visited the hospital for health examination using the Korean Occupational Stress Scale (KOSS)-short form, and the relationship between sociodemographic factors, health-related behaviors, occupational stress, and gastric disease, and the distribution of occupational stress by sociodemographic factors in the gastric disease group was examined. RESULTS: There was no significant association between gastric disease and total occupational stress score and its seven sub-factors. The analysis showed that risk of gastric disease was significantly higher in the Q1 group in which the stress caused by occupational discomfort among seven sub-factors was lowest than that in the Q4 group (odds ratio, 2.819; 95% confidence interval, 1.151 to 6.908). Analysis only on the gastric disease group showed that the stress score of laborers was higher in the four sub-factors than that of office workers (P < 0.05). Analysis on educational background showed that the scores of the three sub-factors were lower in subjects who's highest level of education was high school (P < 0.01). CONCLUSION: This study suggests that it is necessary to improve the culture of Korean collectivism in the workplace and to manage the occupational stress in the low-educated and laborers. It is recommended for future studies to confirm the causal relationship between occupational stress and gastric disease by large scale studies using a KOSS which appropriately reflects workplace culture.

The Effectiveness of Medical Communication Skill of Medical Students, through an Emphasis on Role Play / 고신대학교의과대학학술지

OBJECTIVES: Medical doctors require outstanding communication skills when meeting with their patients. Thus medical student need to education and training about medical communication skill. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. METHODS: In the year 2010 and 2011, first-year medical students at The Kosin University College of Medicine took 'Communication skills' course in total, 154 first-year medical students survey results was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet'. The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. RESULTS: All categories of communication skills showed an improvement. For year 2010, a statistically significant difference was shown into the 22 questions, whereas in 2011, improvements were shown in all questions. CONCLUSIONS: From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.

Targeted Plasma Metabolite Profiling of Metformin in Healthy Korean Volunteers

BACKGROUND: Metformin is an effective oral antihyperglycaemic agent for type 2 diabetes mellitus, with a variety of metabolic effects. In addition to controlling blood glucose level, it has been appeared to decrease the long-period complications of diabetes, including macrovascular disease. Few reports have addressed the metabolite profiling of metformin. The study was to evaluate if targeted metabolic profiling approach is sensitive enough to predict the therapeutic effects of metformin after a single oral dose. METHODS: A randomized, open-label, single-dose study was conducted in twenty eight healthy Korean male volunteers. To determine the concentrations of endogenous metabolites in their pre-dose and post-dose plasma samples, blood samples were collected before and at 2 and 6 h after a single oral dose of 500 mg metformin. Both Modular P/Modular D analyzer and ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS)-based metabolic profiling was performed. RESULTS: We quantified pre-dose and post-dose creatinine, blood urea nitrogen (BUN), lactic acid, 7 amino acids (lysine, glutamic acid, alanine, valine, leucine, phenylalanine, tryptophan), and 5 lysophosphatidylcholines (14:0, 16:0, 17:0, 18:0, and 18:1) using autoanalyser and UPLC-MS/MS. The postdose levels of alanine, lactic acid, glutamic acid, lysine, valine, leucine, phenylalanine, tryptophan, and lysoPC (18:1) were slightly decreased with statistical significance, but there is no clinical significance. CONCLUSION: In order to explore the potential endogenous metabolites associated with the therapeutic effects of metformin, further study including non-targeted (global) metabolite profiling is needed.

Targeted Plasma Metabolite Profiling of Metformin in Healthy Korean Volunteers

BACKGROUND: Metformin is an effective oral antihyperglycaemic agent for type 2 diabetes mellitus, with a variety of metabolic effects. In addition to controlling blood glucose level, it has been appeared to decrease the long-period complications of diabetes, including macrovascular disease. Few reports have addressed the metabolite profiling of metformin. The study was to evaluate if targeted metabolic profiling approach is sensitive enough to predict the therapeutic effects of metformin after a single oral dose. METHODS: A randomized, open-label, single-dose study was conducted in twenty eight healthy Korean male volunteers. To determine the concentrations of endogenous metabolites in their pre-dose and post-dose plasma samples, blood samples were collected before and at 2 and 6 h after a single oral dose of 500 mg metformin. Both Modular P/Modular D analyzer and ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS)-based metabolic profiling was performed. RESULTS: We quantified pre-dose and post-dose creatinine, blood urea nitrogen (BUN), lactic acid, 7 amino acids (lysine, glutamic acid, alanine, valine, leucine, phenylalanine, tryptophan), and 5 lysophosphatidylcholines (14:0, 16:0, 17:0, 18:0, and 18:1) using autoanalyser and UPLC-MS/MS. The postdose levels of alanine, lactic acid, glutamic acid, lysine, valine, leucine, phenylalanine, tryptophan, and lysoPC (18:1) were slightly decreased with statistical significance, but there is no clinical significance. CONCLUSION: In order to explore the potential endogenous metabolites associated with the therapeutic effects of metformin, further study including non-targeted (global) metabolite profiling is needed.

The Effect of Vitamin C for Mercury Excretion by Hair Mercury Analysis / 가정의학회지

BACKGROUND: Humans are exposed to mercury via many different routes and in different forms. Studies concerned with the exposure in the general population were done many times in the past. But, the treatment of mercury exposure and mercury intoxication is limited. Therefore, chelators such as birth anti lewistite, 2,3-dimercaptopropanol (BAL), dimercaptopropane-1-sulphonate (DMPS), and dimercaptosuccinic acid (DMSA) were given to patients with acute symptoms resulting from the central nervous system due to confirmed mercury poisoning. In this paper, we reported the effects of oral Vitamin C on mercury excretion. METHODS: This study has been reviewed in the clinical findings of 213 patients aged 30-80 who visited Kosin University Gospel Hospital during 3 months from March to September 2007. We measured hair mercury levels at the initial visit and at 3-4 months after the oral vitamin C (4 g/day) treatment. RESULTS: The number of patients who had initial hair mercury level over 1.5 ppm were 57 patients among 213 patients, and 41 patients rechecked the hair mercury level. Twenty patients who had hair mercury level over 1.5 ppm were treated with oral vitamin C for 3 months and rechecked the hair mercury level and 21 patients without vitamin C treatment. The vitamin treatment group had a hair mercury level that was three times lower than the non-treated group. CONCLUSION: The vitamin C oral treatment significantly decreased the level of hair mercury.