The Impact of Withdrawing or Withholding of Life-Sustaining Treatment: A Nationwide Case-Control Study Based on Medical Cost Analysis

This study measured the impact of the Decisions on Life-Sustaining Treatment Act by analyzing medical cost data from the National Health Insurance Service-National Sample Cohort. After identifying the patients who died in 2018 and 2019, the case and control groups were set using the presence of codes for managing the implementation of life-sustaining treatment with propensity score matching. Regarding medical costs, the case group had higher medical costs for all periods before death. The subdivided items of medical costs with significant differences were as follows: consultation, admission, injection, laboratory tests, imaging and radiation therapy, nursing hospital bundled payment, and special equipment.This study is the first analysis carried out to measure the impact of the Decision on LifeSustaining Treatment Act through a cost analysis and to refute the common expectation that patients who decided to withhold or withdraw life-sustaining treatment would go through fewer unnecessary tests or treatments.

A Preliminary Study to Improve Death Education for the Public and Medical Students after the Enforcement of the Life-Sustaining Treatment Decision Act / 의학교육논단

Considering the recent medicalization of death, the importance of preparing both laypersons and medical students to have meaningful end-of-life conversations, which is among the objectives of death education, will grow. The Act of Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life provided a new source of momentum to death education for both laypersons and medical professionals, as the importance of education on death is widely recognized. However, problems remain regarding how to prepare people for productive conversations at the end-of-life and how to secure the continuity of care. Different focuses and deficiencies are observed in death education programs for each category of learner. In education for laypeople, tangible information on how to actualize one’s existential and personal understanding of death through real-life options is lacking, except for presenting the “protocol” of the Act. Conversely, basic medical education lacks an understanding of or confrontation with death on the existential and personal levels. Death education should aim to build a shared understanding that can facilitate communication between the two groups. The scant overlap between layperson education and basic medical education even after the Act’s enactment is worrisome. Further fundamental changes in death education are required regarding its content. Topics that patients and doctors can share and discuss regarding death and end-of-life care should be discovered and provided as educational content both to laypeople and future medical professionals.

Barriers to Informed refusal in Korea / Obstáculos al rechazo informado en Corea / Barreiras à recusa informada na Coreia

Abstract In South Korea, the legal and cultural environment keeps terminally ill patients from making an informed refusal to a treatment the discontinuation of which can cause death. Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life allows several forms of informed refusal, but it is not enough. There is no explicit guarantee, at least under this law, of the right to refuse a treatment given during a period that has not reached an end-of-life process prescribed in the law. Dori, which the family of a terminal patient feels obligated to follow, makes them commit to doing what they believe is right as a family member without asking the patient's intention. Because it reduces the family's motivation to have a difficult talk about death and end-of-life with the patient, the patient is deprived of an opportunity to make a decision based on accurate information. In making a decision for the patient while patient is excluded, the family often ends up choosing a safe decision that puts physical survival first. In conclusion, the culture and the culturally influenced law are making it impractical for terminal patients to make an informed refusal.

Resumen: En Corea del Sur, el entorno legal y cultural impide a los pacientes terminales rechazar con conocimiento de causa un tratamiento cuya interrupción puede causar la muerte. La Ley de Decisiones sobre el Tratamiento de Mantenimiento de la Vida para Pacientes en Hospicio y Cuidados Paliativos o al Final de la Vida permite varias formas de rechazo informado, pero no es suficiente. No se garantiza explícitamente, al menos en esta ley, el derecho a rechazar un tratamiento administrado durante un periodo que no ha llegado a un proceso de final de vida prescrito en la ley. La ley Dori, que la familia de un paciente terminal se siente obligada a seguir, les hace comprometerse a hacer lo que creen correcto como familiares, sin preguntar la intención del paciente. Dado que reduce la motivación de la familia para tener una charla difícil sobre la muerte y el final de la vida con el paciente, éste se ve privado de la oportunidad de tomar una decisión basada en información precisa. Al tomar una decisión por el paciente mientras se le excluye, la familia suele acabar eligiendo una decisión segura que antepone la supervivencia física. En conclusión, la ley, influenciada por la cultura, está haciendo que sea poco práctico para los pacientes terminales hacer un rechazo informado.

Resumo Na Coreia do Sul, o ambiente legal e cultural mantém pacientes com doença terminal à parte de fazer uma recusa informada a um tratamento cuja descontinuação pode causar morte. O Ato sobre Decisões a respeito de Tratamento de Suporte à Vida para Pacientes em Lares de Idosos e Cuidados Paliativos ou ao Fim da Vida permite diversas formas de recusa informada mas não é suficiente. Não há uma garantia explícita, pelo menos sob esta lei, do direito de recusar um dado tratamento durante um período que não alcançou um processo de fim-da-vida prescrito na lei. Dori, que a família de um paciente terminal sente-se obrigada a seguir, faz com que eles se comprometam a fazer o que eles acreditam ser certo como um membro da família, sem perguntar a intenção do paciente. Na medida em que isto reduz a motivação da família em ter uma conversa difícil sobre morte e fim-da-vida com o paciente, o paciente é privado de uma oportunidade de tomar uma decisão baseada em informação precisa. Ao tomar uma decisão pelo paciente enquanto ele é excluído, a família frequentemente termina escolhendo uma decisão segura que coloca a sobrevivência física em primeiro lugar. Em conclusão, a cultura e a lei influenciada pela cultura estão tornando impraticável para pacientes terminais fazer uma recusa informada.

Recent Decrease in Organ Donation from Brain-Dead Potential Organ Donors in Korea and Possible Causes

Background@#In 1999, the Organ Transplantation Act legalized organ donation from brain-dead patients. As a result of the government's continued efforts, the number of brain-dead donors steadily increased from 2002 through 2016. However, the number has declined since 2017. This paper examined the possible reasons behind the decline in brain-dead organ donation. @*Methods@#This investigation was an analysis of published data from the Korea Organ Donation Agency annual reports from 2013 to 2018. @*Results@#The number of brain-dead organ donors in Korea rose steadily until 2016, declined in 2017 for the first time since 2002, and then dropped sharply in 2018. Although the number of brain-dead potential organ donors increased between 2017 and 2018, the number of eligible donors decreased, suggesting that patient families rejected the brain-death determination process and brain-dead organ donation. Statistics gathered during identification of brain-dead potential donors and actual donations confirm that rejection or withdrawal of consent by the family has increased. During the same period when donation from brain- dead patients decreased, five events occurred: 1) compensation for donor families was abolished; 2) an incident of mistreatment of a brain-dead donor's remains occurred; 3) the Life-Sustaining Treatment Act was enacted, providing a legal procedure whereby families of brain-dead patients could forgo life-sustaining treatment; 4) residents' work week was limited to 80 hours; and 5) the Labor Standards Law was amended. @*Conclusion@#Fewer eligible donors in spite of an increase in brain-dead potential organ donors suggests that reduction in these donations resulted mainly from factors associated with family consent. Among such factors, implementation of the Life-sustaining Treatment Act appears to be most important. Abolition of family compensation and the incident in which a brain-dead donor's remains were mistreated may also have influenced family consent.

Prevalence and Predictors of Polypharmacy among Elderly Outpatients in a Public Hospital

Background@#Polypharmacy, the use of multiple drugs, is a growing concern in older adults. It has been reported that the prevalence of polypharmacy in elderly patients is higher in Korea than in other countries. The objective of this study was to investigate the prevalence and associated factors of polypharmacy in elderly outpatients who visited a Seoul Medical Center. @*Methods@#We retrospectively reviewed medical records of 12,551 elderly patients aged ≥65 years who visited outpatient clinics in a public hospital in Seoul between January 1, 2018 and December 31, 2018. We defined “polypharmacy” as the use of ≥6 medications per person; “major polypharmacy,” ≥11 medications per person; and “excessive polypharmacy,” ≥21 medications per person. Multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to investigate the risk factors for polypharmacy. @*Results@#Among the elderly outpatients studied, 40.7% had polypharmacy, 11.9% major polypharmacy, and 0.8% excessive polypharmacy. The lowerincome medical aid population is associated with polypharmacy (OR, 1.70; 95% CI, 1.47–1.97). @*Conclusion@#We observed a high prevalence of polypharmacy in elderly outpatients, especially the medical aid population, who visited a Korean public hospital. Nationwide vigorous efforts to assess and reduce the prevalence of polypharmacy are urgently required for the Korean older population.

Recent Decrease in Organ Donation from Brain-Dead Potential Organ Donors in Korea and Possible Causes

Background@#In 1999, the Organ Transplantation Act legalized organ donation from brain-dead patients. As a result of the government's continued efforts, the number of brain-dead donors steadily increased from 2002 through 2016. However, the number has declined since 2017. This paper examined the possible reasons behind the decline in brain-dead organ donation. @*Methods@#This investigation was an analysis of published data from the Korea Organ Donation Agency annual reports from 2013 to 2018. @*Results@#The number of brain-dead organ donors in Korea rose steadily until 2016, declined in 2017 for the first time since 2002, and then dropped sharply in 2018. Although the number of brain-dead potential organ donors increased between 2017 and 2018, the number of eligible donors decreased, suggesting that patient families rejected the brain-death determination process and brain-dead organ donation. Statistics gathered during identification of brain-dead potential donors and actual donations confirm that rejection or withdrawal of consent by the family has increased. During the same period when donation from brain- dead patients decreased, five events occurred: 1) compensation for donor families was abolished; 2) an incident of mistreatment of a brain-dead donor's remains occurred; 3) the Life-Sustaining Treatment Act was enacted, providing a legal procedure whereby families of brain-dead patients could forgo life-sustaining treatment; 4) residents' work week was limited to 80 hours; and 5) the Labor Standards Law was amended. @*Conclusion@#Fewer eligible donors in spite of an increase in brain-dead potential organ donors suggests that reduction in these donations resulted mainly from factors associated with family consent. Among such factors, implementation of the Life-sustaining Treatment Act appears to be most important. Abolition of family compensation and the incident in which a brain-dead donor's remains were mistreated may also have influenced family consent.

A Qualitative Study of Students' Perception on Premedical Curriculum / 이화의대지

OBJECTIVES: A Womans University College of Medicine faces curriculum reform in 2020. To determine what reforms are needed in the premedical curriculum, a needs assessment was conducted.METHODS: This study utilizes qualitative study method. A focus group interview was conducted with four students who completed premedical courses from November to December 2018. Interviews were conducted in two groups by grade level, and each interview was recorded. After transcribing the recorded contents, four researchers analyzed the data using conventional content analysis.RESULTS: Students chose A Womans University College of Medicine considering their future careers as female medical professionals and other considerations such as scholarships. The students expected diverse experiences, exchanges with students in different departments, and fusion of medicine with other fields during their premedical years. Overall, these expectations were met during the course, but individual needs for customized education, such as liberal arts, were unmet. In general, students' attitudes toward premedical courses were very motivated and they actively used resources provided by the university.CONCLUSION: Qualitative research can provide a better understanding of quantitative data, such as a student survey performed to prepare for curriculum reform. Based on this understanding, the curriculum will be reformed to reflect the educational needs of students, to motivate students and to provide satisfactory education.

Challenges and Opportunities in Clinical Ethics with the Implementation of Korea's End-of-Life Act / Desafíos y oportunidades en ética clínica con la implementación de la Ley de fin de vida de Corea / Desafios e oportunidades em ética clínica com a implementação do Ato de Fim-da-Vida na Córeia

Abstract: This paper examines the possible impacts of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life in Korea (Korea's end-of-life act), legislated in 2016, on the development of hospital ethics committees and clinical ethics consultation services in South Korea. Clinical ethics in Korea has not made much progress in comparison to other subdisciplines of biomedical ethics. While the enactment of this law may give rise to beneficial clinical ethics services, it is possible that customary practices and traditional authorities in Korean society will come into conflict with the norms of clinical ethics. This paper examines how the three main agents of Korean society—family, government, and medical professionals—may clash with end-of-life stage norms in clinical ethics, thus posing obstacles to the development of hospital committees and consultation services. A brief outline of what lies ahead for the progress of clinical ethics practice is explored.

Resumen: Este documento examina los posibles impactos de la Ley de decisiones sobre el tratamiento de soporte vital para pacientes en hospicios y cuidados paliativos, o al final de la vida en Corea (Ley de Corea del Final de la Vida), legislada en 2016, sobre el desarrollo de comités de ética hospitalaria y servicios de consulta de ética clínica en Corea del Sur. La ética clínica en Corea no ha avanzado mucho en comparación con otras subdisciplinas de la ética biomédica. Si bien la promulgación de esta ley puede dar lugar a servicios de ética clínica beneficiosos, es posible que las prácticas tradicionales y las autoridades tradicionales en la sociedad coreana entren en conflicto con las normas de ética clínica. Este documento examina cómo los tres agentes principales de la sociedad coreana —familia, gobierno y profesionales médicos— pueden chocar con las normas de ética clínica al final de la vida, lo que plantea obstáculos para el desarrollo de comités hospitalarios y servicios de consulta. Se explora un breve resumen de lo que queda por delante para el progreso de la práctica de la ética clínica.

Resumo: Este artigo examina os possíveis impactos que o Ato sobre Decisões Relacionadas a Tratamento de Manutenção da Vida para Pacientes em Casas de Idosos e de Cuidados Paliativos ou ao Fim da Vida na Coréia (ato de fim da vida da Coréia), aprovado pelo legislativo em 2016, sobre o desenvolvimento de comitês de ética de hospitais e serviços de consulta sobre ética clínica na Coréia do Sul. Ética clínica na Coréia não sofreu muito progresso em comparação com outras subdisciplinas da ética biomédica. Enquanto a promulgação desta lei pode dar origem a serviços de ética clínica proveitosos, é possível que práticas usuais e autoridades tradicionais na sociedade coreana entrarão em conflito com as normas da ética clínica. Este artigo examina como os três principais agentes da sociedade coreana - família, governo e profissionais médicos - podem se chocar com normas de estágios de fim da vida em ética clínica, colocando assim obstáculos para o desenvolvimento de comitês hospitalares e serviços de consulta. Um breve esboço do que vem pela frente para o progresso da prática de ética clínica é explorado.

Use of Haloperidol and Lorazepam for Intractable Symptoms in the Hospice Palliative Care Unit

BACKGROUND: Terminally ill cancer patients suffer from refractory symptoms, and the last option of treatment is to consider sedatives. However, due to concerns that sedation may shorten survival time, some people prefer not to take sedatives. The purpose of this study was to investigate the effects of sedative administration on survival time among terminally ill cancer patients.METHODS: Two hundreds and thirty-seven patients who were hospitalized to the hospice care unit of public hospitals in Seoul from January, 2015 to March, 2016 were analyzed retrospectively. The univariate and multivariate Cox's proportional hazard regression model was used to determine independent factors related to survival time.RESULTS: The usage of sedation was necessary because the incidence of insomnia was 61.4% in the lorazepam only group, and the incidence of delirium was highest in the haloperidol group and the haloperidol with lorazepam group. Interestingly, multivariate analysis showed that male (HR, 1.766; P < 0.001), decreased consciousness (HR, 1.803; P=0.003), anorexia (HR, 1.506; P=0.012), resting dyspnea (HR, 1.757; P < 0.001), elevated serum bilirubin (HR, 1.657; P=0.001), and the haloperidol with lorazepam group (HR, 0.535, P < 0.001) were each significantly associated with survival time. Furthermore, patients in the haloperidol with lorazepam group survived longer than patients with no such medications.CONCLUSION: There is no evidence that treatment with sedative medication shortens the survival time of patients with terminally ill cancer with refractory symptoms.

Association of Work-Time, Leisure-Time Physical Activity and Osteoporosis Prevalence: Korea National Health and Nutrition Examination Survey in 2015–2016

BACKGROUND: Physical activity is an important factor for preventing osteoporosis. This study aimed to investigate the association of work- and leisure-time physical activities with osteoporosis in postmenopausal women.METHODS: Data were obtained from the Korea National Health and Nutritional Examination Survey 2015–2016. A total of 2,885 postmenopausal women were included in the analysis. The subjects were divided into 3 groups according to the intensity of the work- and leisure-time physical activities. T-test, chi-square test, and multivariable logistic regression analysis were used.RESULTS: No association was found between work-time physical activity and osteoporosis prevalence. However, a dose-response relationship was found in case of leisure-time physical activity. People with leisure-time physical activity of at least >1,000 MET-min/week showed lower prevalence of osteoporosis.CONCLUSION: An appropriate level of leisure-time physical activity should be recommended to prevent and treat osteoporosis.

The assisted reproductive technology subsidy in Korea: criticism from a perspective of reproductive responsibility / El subsidio para la tecnología de reproducción asistida en Corea: crítica desde una perspectiva de responsabilidad reproductiva / A subvenção tecnológica de reprodução assistida na Coreia: uma crítica a partir de uma perspectiva de responsabilidade reprodutiva

The Korean government's new policy of subsidizing assisted reproductive technology (ART) fees to increase the birth rate reflects a lack of concern for future generations and their quality of life. It seems wrong to treat the future child as just a number that contributes to achieving the target birth rate, or as a mere means of solving a problem facing the current generation. However, when one tries to articulate the shortcomings of this new policy, one realizes that the ontological arguments surrounding this issue, namely the non-identity problem is complex. I propose the concept of reproductive responsibility as a response to the possible life. This concept presupposes a relationship between the reproductive agent and the possible new life. Since the concept draws the normative standard from that relationship, it resolves the non-identity problem and makes it possible to criticize the new policy of subsidizing ART.

La nueva política del gobierno de Corea de proporcionar subsidio para los costos de la tecnología de reproducción asistida (TRA), para incrementar el número de nacimientos, refleja falta de preocupación por las futuras generaciones y su calidad de vida. Parece equivocado tratar a un niño futuro como un número que contribuye a lograr la frecuencia de nacimientos objetivo, como un mero medio para resolver un problema que enfrenta la generación presente. Sin embargo, cuando uno trata de articular las deficiencias de esta nueva política, se da cuenta de que los argumentos ontológicos sobre el tema son complejos, principalmente el problema de falta de identidad. Propongo el concepto de "responsabilidad reproductiva" como respuesta a la posible vida. Este concepto presupone una relación entre el agente reproductivo y la posibilidad de nueva vida. Debido a que el concepto extrae su normatividad de esta relación, se resuelve el problema de falta de identidad y hace posible criticar la nueva política de proporcionar subsidio a TRA.

A nova política de governo coreano de subsidiar a tecnologia de reprodução assistida (ART) para aumentar a taxa de natalidade reflete uma falta de preocupação com a geração futura e sua qualidade de vida. Parece errado tratar a futura criança como apenas um número que contribui para atingir a meta de taxa de natalidade, ou como um mero meio de resolver um problema que enfrentam a atual geração. No entanto, quando tenta-se articular as deficiências desta nova política, percebe-se que os argumentos ontológicos em torno desta questão, ou seja o problema da não-identidade é complexo. Eu proponho o conceito de responsabilidade reprodutiva como uma resposta para a vida possível. Este conceito pressupõe uma relação entre o agente reprodutivo e a possível nova vida. Uma vez que o conceito desenha um padrão normativo desta relação, ele resolve o problema da não-identidade e torna possível criticar a nova política de subsidiar ART.

In order to be medically correct, we must be politically correct in class / 한국의학교육

No abstract available.

Who should be a parent? Parenthood and the significance of reproductive choice / Quién debería ser padre? Paternidad y la importancia de elección reproductive / Quem deve ser um pai? Paternidade e a importância da escolha reprodutiva

The various reproductive technologies have expanded the power people have to control their bodily function. Because these technologies have brought new configurations of people whose role is central to the reproductive process, ambiguities about the attribution of parenthood have emerged. I insist that the intentional account among four explanatory frameworks for parenthood gains more validity, as opportunities to exert intention increase. I extend the intentional account, using Scanlon's explanation of the "Value of Choice." In the Value of Choice, Scanlon explains that choice has a justificatory power; that is, by the fact of having choice, one accepts the normative consequences of one's decision. The current changes in reproduction technologies mean that there are several conditions to choose. While maintaining justificatory power from the Value of Choice, the intentional account becomes inclusive enough to encompass the status quo, plausible even in situations where intention does not exist or is not exerted.

La variedad de tecnologías reproductivas han expandido el poder que las personas tienen para controlar su función corporal. Debido a que estas tecnologías han producido nuevas configuraciones de personas cuyo papel es central para el proceso reproductivo, han emergido ambigüedades sobre la atribución de paternidad. Insisto en que dar cuenta de la intencionalidad en la paternidad dentro de cuatro estructuras explicativas gana mayor validez en la medida en que se incrementan las oportunidades de ejercer intención. Extiendo el dar cuenta de la intención usando la explicación de Scanlon sobre el "Valor de la Elección", en la cual la elección tiene un poder de justificación; esto es, por el hecho de haber elegido, uno acepta las consecuencias normativas de su decisión. Los cambios actuales en tecnologías de reproducción significan que existen varias condiciones para elegir; mientras que se mantiene el poder de justificación por el Valor de Elección, el dar cuenta de la intención llega a ser lo suficientemente inclusivo para abarcar el statu quo, plausible incluso en situaciones en que no existe intención o no se expresa.

As várias tecnologias reprodutivas expandiram o poder que as pessoas têm de controlar suas funções corporais. Porque estas tecnologias trouxeram novas configurações de pessoas cujo papel é fundamental para o processo reprodutivo, ambiguidades emergiram sobre a atribuição da paternidade. Eu insisto que a consideração intencional entre quatro quadros explicativos para a paternidade ganha mais validade, quando oportunidades de exercer a intenção de aumentam. Eu estendo a consideração intencional, utilizando a explicação de Scanlon, do "Valor de escolha". Scanlon explica que a escolha tem um poder de justificação; ou seja, pelo fato de ter uma escolha, um aceita as consequências normativas de uma decisão. As atuais mudanças em tecnologias de reprodução significam que existem várias condições para escolher. Enquanto mantendo o poder de justificação do valor da escolha, a consideração intencional torna-se suficientemente inclusiva para abranger o status quo, plausível mesmo em situações onde uma intenção não existe ou não é exercida.

The Effects of Peer Assessment and Peer Feedback in Writing Education for Premedical Students / 이화의대지

OBJECTIVES: There are several problems which hamper the successful teaching of writing in medical education. To deal with these problems, teachers should be conscious of two general questions; what to teach in writing class for premedical students; and how to utilize the writing class time. This paper examines the value of peer assessment and peer feedback in dealing with those questions. METHODS: This paper reviews a subject in premedical education, Logical Thinking and Writing, from the perspective of peer assessment and peer feedback. RESULTS: Students accomplished the learning objectives and they recognized the value of peer assessment and feedback. CONCLUSION: Peer assessment and peer feedback foster students' participation in class and accelerate the learning process. This strategy reminds students of the fact that they are writing an essay for an audience.

Implementation of Outcome-Based Medical Education Theory into the Pre-existing Curriculum / 이화의대지

OBJECTIVES: This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically. METHODS: We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development. RESULTS: The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring. CONCLUSION: Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.

Current status and plans for development of medical self-regulation in Korea

Following several medical scandals, the issue of medical regulation has come under the spotlight in the Republic of Korea. In this article, the authors examine the administrative measures newly required of doctors in the past five years in order to illustrate the current state of medical regulation and demonstrate the urgent need for self-regulation. The history of the General Medical Council in the United Kingdom and its newly launched system of "revalidation" can provide an instructive example of a self-regulation system, and it suggests several principles for self-regulation in Korea. The recent disarray can be viewed as an opportunity to introduce a new system of self-regulation. The authors present three principles-professionalism, transparency, and fairness-for a successful system of medical regulation.

Severe Endobronchial Inflammation Induced by Aspiration of a Ferrous Sulfate Tablet / 결핵및호흡기질환

Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.

Korean doctors' perception on doctor's social competency: based on a survey on doctors

Medicine is the practice that occurs in the context of the society. It requires interaction with individual patients, fellow doctors and other health care professionals, health care officials, public, institution, and the society as a whole. To date, medical practice in Korea has largely been concentrated on applying biomedical knowledge and skill to a patient. We defines 'social competency' as 'competency for medicine as a social institution.' This survey aims to grasp the current situation of Korean doctors' perception on social competency, in terms of necessity, satisfaction, learning experience, and possible intervention. Respondents generally recognized the necessity of social competencies but were not satisfied with their demonstration of those competencies. Competencies for 'understanding on law and institution' and 'communication' were perceived highly necessary. General satisfaction and each satisfaction rate on individual competencies were all below 'neutral,' showing their dissatisfaction. Especially, doctors assess their fellow doctors' competencies for 'understanding on law and institution' and 'understanding on human being and society' at the lowest level. The mismatch between perceived necessity and satisfaction shows the legitimate ground for educational intervention. The proportions of respondents who have learned on each domain of social competency were all below 70%. Learning experience on self-management and leadership was the least. Among possible remedy for low social competency, respondents perceived 'improvement on national health insurance' and 'improvement on resident training program' as the most urgently needed. The data from this preliminary survey can be utilized for educational and institutional intervention in the future.

The Relationship between Prevalence of Osteoporosis and Proportion of Daily Protein Intake / 가정의학회지

BACKGROUND: The association between daily protein intake and osteoporosis is still controversial and only a few studies have explored the issue in Korea. This study investigated the relationship between daily protein intake and the prevalence of osteoporosis in Korean adults. METHODS: This study analyzed data extracted from the Korean National Health and Nutrition Examination Survey 4. Participants were aged 19 years or older and had never been treated for osteoporosis. The percentage of calories coming from protein intake was assessed by 24-hour recall method, and participants were divided into three groups according to recommended daily dietary protein intake as a proportion of total daily calories (i.e., 20%). A lumbar or femur neck bone mineral density T-score less than -2.5 was indicative of the presence osteoporosis. The influence of daily protein intake on the prevalence of osteoporosis was analyzed. RESULTS: In both sexes, the group with the highest protein intake had significantly lower odds of developing lumber osteoporosis when compared to the group with the lowest protein intake, after adjusting for associated factors (females: odds ratio [OR], 0.618; 95% confidence interval [CI], 0.610 to 0.626; P for trend <0.001; males: OR, 0.695; 95% CI, 0.685 to 0.705; P for trend <0.001). CONCLUSION: Sufficient daily protein intake lowered the prevalence of osteoporosis in Korean adults. Further prospective studies are necessary to verify the preventive effect of adequate protein intake on osteoporosis.

Coffee Consumption and Stroke Risk: A Meta-analysis of Epidemiologic Studies / 가정의학회지

BACKGROUND: Coffee is one of the most widely consumed beverages in the world, and contains caffeine and phenolic compounds. Many studies on the association between coffee consumption and risk of stroke have been reported, however, more research is needed to further explore many studies' inconsistent results. Therefore, we conducted a meta-analysis to verify the relationship between coffee consumption and stroke. METHODS: We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library, using the keywords "coffee" or "caffeine" for the exposure factors, and "transient ischemic attack" or "stroke" or "acute cerebral infarction" or "cardiovascular events" for the outcome factors. We included prospective cohort and case-control studies published between 2001 and July 2011 in this review. The search was limited to English language. RESULTS: Among 27 articles identified for this review, only 9 studies met the inclusion criteria, all of which were cohort studies. When using all cohort studies, the pooled relative risk (RR) of stroke for the highest vs. lowest category of coffee consumption was 0.83 (95% confidence interval [CI], 0.76 to 0.91). When subgroup analysis was performed, for Europeans, increased coffee drinking showed a preventive effect on stroke occurrence with RR 0.82 (95% CI, 0.74 to 0.92); RR for women 0.81 (95% CI, 0.70 to 0.93); for ischemic stroke 0.80 (95% CI, 0.71 to 0.90); and for those drinking 4 cups or more per day 0.83 (95% CI, 0.75 to 0.91). CONCLUSION: We found that coffee consumption of 4 cups or more per day showed a preventive effect on stroke in this meta-analysis.